Healthcare Provider Details
I. General information
NPI: 1740370147
Provider Name (Legal Business Name): ANESTHESIA ADVANTAGE OF DELAWARE, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 10/14/2006
Last Update Date: 08/15/2022
Certification Date: 08/15/2022
Deactivation Date:
Reactivation Date:
III. Provider practice location address
17015 OLD ORCHARD RD STE 4
LEWES DE
19958-4849
US
IV. Provider business mailing address
12 NEWBURYPORT RD
LANGHORNE PA
19053-1556
US
V. Phone/Fax
- Phone: 215-860-4110
- Fax: 215-860-2093
- Phone: 215-860-4110
- Fax: 267-295-8208
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207L00000X |
| Taxonomy | Anesthesiology Physician |
| License Number | |
| License Number State | |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 367500000X |
| Taxonomy | Certified Registered Nurse Anesthetist |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: DR.
JOHN
G
CARESTIA
Title or Position: PRESIDENT
Credential: MD
Phone: 215-860-4110