Healthcare Provider Details

I. General information

NPI: 1073901054
Provider Name (Legal Business Name): ANESTHESIA SERVICES, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2014
Last Update Date: 12/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4755 OGLETOWN STANTON RD
NEWARK DE
19718-2200
US

IV. Provider business mailing address

2 READS WAY SUITE 201
NEW CASTLE DE
19720-1607
US

V. Phone/Fax

Practice location:
  • Phone: 302-733-1000
  • Fax:
Mailing address:
  • Phone: 302-356-3081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberL6-0A00715
License Number StateDE

VIII. Authorized Official

Name: MS. CHRISTINE MACK
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 302-356-3081