MEDICARE: GREENE COUNTY ANESTHESIA SERVICES,PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician

General Provider Information

NPI Number	:	1205811734
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREENE COUNTY ANESTHESIA SERVICES,PC

Provider Business Mailing Address
First Line	:	736 W INGOMAR RD UNIT 116
Second Line	:
City	:	INGOMAR
State	:	PA
Zip	:	15127-6604
Country	:	US
Telephone Number	:	724-550-4211
Fax Number	:

Provider Business Practice Location Address
First Line	:	4240 SECOR RD
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43623-4238
Country	:	US
Telephone Number	:	724-812-5754
Fax Number	:	724-812-5581

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SUDHAKAR B. MANNAM
Credential	:	MD
Telephone Number	:	724-812-5580

Provider Enumeration Date	:	12/07/2005
Last Update Date	:	08/12/2021

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