Healthcare Provider Details

I. General information

NPI: 1164427670
Provider Name (Legal Business Name): SOUTHERN NEW ENGLAND ANESTHESIA CONSULTANTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 PARK ST
ATTLEBORO MA
02703-3143
US

IV. Provider business mailing address

PO BOX 6208
PROVIDENCE RI
02940-6208
US

V. Phone/Fax

Practice location:
  • Phone: 508-222-5200
  • Fax:
Mailing address:
  • Phone: 201-804-2800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: SUSAN B POLLAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 508-222-5200