Individual
JOSEPH LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
2401 W BELVEDERE AVE, ANESTHESIA DEPARTMENT, BALTIMORE, MD 21215-5216
(410) 601-5209
Mailing address
68 S SERVICE RD, SUITE 350, MELVILLE, NY 11747-2354
(516) 945-3000
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R080788
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
018400400
—
MD
Enumeration date
07/26/2005
Last updated
10/28/2009
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