Organization
FADE TO BLACK ANESTHESIA SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RAJAEE BLACK CRNA (OWNER)
(215) 500-7580
Entity
Organization
Contact information
Practice address
7501 FORBES BLVD STE 103, LANHAM, MD 20706-6201
(215) 500-7580
Mailing address
PO BOX 731, LAUREL, MD 20725-0731
(215) 500-7580
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
—
—
367500000X
Certified Registered Nurse Anesthetist
Primary
—
—
Other
Enumeration date
01/03/2019
Last updated
01/03/2019
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