Organization
CARROLL COUNTY MSO INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VAJIRA GUNAWARDANE MD (PHYSICIAN DIRECTOR)
(410) 871-6139
Entity
Organization
Contact information
Practice address
208 E RIDGEVILLE BLVD, 201, MOUNT AIRY, MD 21771-5219
(301) 829-7683
(301) 829-7694
Mailing address
291 STONER AVE, WESTMINSTER, MD 21157-5647
(410) 871-6139
(410) 871-6112
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
D0047120
MD
Other
Enumeration date
01/16/2007
Last updated
10/16/2007
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