Healthcare Provider Details

I. General information

NPI: 1104339902
Provider Name (Legal Business Name): METROWEST ANESTHESIA ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2017
Last Update Date: 06/26/2024
Certification Date: 06/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 LINCOLN ST
FRAMINGHAM MA
01702-6358
US

IV. Provider business mailing address

PO BOX 4110
WOBURN MA
01888-4110
US

V. Phone/Fax

Practice location:
  • Phone: 508-383-1000
  • Fax:
Mailing address:
  • Phone: 508-599-2200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: STEFAN HARISKOV
Title or Position: CO-TREASURER
Credential: MD
Phone: 617-610-6801