MEDICARE: ANESTHESIA DYNAMICS LLC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629644778
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANESTHESIA DYNAMICS LLC

Provider Business Mailing Address
First Line	:	LB #8247 PO BOX 95000
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19195-0001
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2416 LYNNDALE RD
Second Line	:
City	:	FERNANDINA BEACH
State	:	FL
Zip	:	32034-5201
Country	:	US
Telephone Number	:	904-432-1521
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	LAURA G ADKINS
Credential	:
Telephone Number	:	240-469-2181

Provider Enumeration Date	:	05/31/2021
Last Update Date	:	09/16/2022

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Directions to “ANESTHESIA DYNAMICS LLC ” Practice Location

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