MEDICARE: PROFESSIONAL ANESTHESIA SERVICES OF EASTERN PENNSYLVANIA, P.C.

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
2	367500000X	Certified Registered Nurse Anesthetist

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	CJ8874	OTHER	PA	TRAVELERS MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	001370187	OTHER		HIGHMARK BS

General Provider Information

NPI Number	:	1992776553
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROFESSIONAL ANESTHESIA SERVICES OF EASTERN PENNSYLVANIA, P.C.

Provider Business Mailing Address
First Line	:	7918 MAIN ST
Second Line	:	SUITE 204
City	:	FOGELSVILLE
State	:	PA
Zip	:	18051-1744
Country	:	US
Telephone Number	:	610-428-1544
Fax Number	:	610-395-9336

Provider Business Practice Location Address
First Line	:	7918 MAIN ST
Second Line	:	SUITE 204
City	:	FOGELSVILLE
State	:	PA
Zip	:	18051-1744
Country	:	US
Telephone Number	:	610-428-1544
Fax Number	:	610-395-9336

Authorized Official
Title or Position	:	OWNER
Name	:	JOSEPH D'AMICO
Credential	:	CRNA
Telephone Number	:	610-428-1544

Provider Enumeration Date	:	01/31/2006
Last Update Date	:	02/16/2010

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