Healthcare Provider Details

I. General information

NPI: 1235033523
Provider Name (Legal Business Name): AGELESS FACILITY ANESTHESIA PARTNERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1133 21ST ST NW STE 200
WASHINGTON DC
20036-3324
US

IV. Provider business mailing address

5361 GREENWICH CIR
UPPER MARLBORO MD
20772-4862
US

V. Phone/Fax

Practice location:
  • Phone: 504-202-7479
  • Fax:
Mailing address:
  • Phone: 504-202-7479
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: ALEXIS BENNETT
Title or Position: OWNER
Credential: CRNA
Phone: 504-202-7479