Healthcare Provider Details

I. General information

NPI: 1619020385
Provider Name (Legal Business Name): PROFESSIONAL ANESTHESIA SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 02/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 BEISER BLVD SUITE 201
DOVER DE
19904-8208
US

IV. Provider business mailing address

240 BEISER BLVD SUITE 201
DOVER DE
19904-8208
US

V. Phone/Fax

Practice location:
  • Phone: 301-734-7105
  • Fax:
Mailing address:
  • Phone: 301-734-7105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. GANESH R BALU
Title or Position: PRESIDENT
Credential:
Phone: 302-734-7246