Healthcare Provider Details

I. General information

NPI: 1477507598
Provider Name (Legal Business Name): MVP ANESTHESIA ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 11/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 WASHINGTON ST ANESTHESIA DEPARTMENT
NORWOOD MA
02062-3487
US

IV. Provider business mailing address

PO BOX 845044
BOSTON MA
02284-5044
US

V. Phone/Fax

Practice location:
  • Phone: 781-278-6524
  • Fax: 781-762-1750
Mailing address:
  • Phone: 800-720-1664
  • Fax: 207-753-2020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: BRUCE NOVIS
Title or Position: MANAGING PARTNER
Credential: M.D.
Phone: 781-278-6524