Healthcare Provider Details

I. General information

NPI: 1629723002
Provider Name (Legal Business Name): CAPA ANESTHESIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2022
Last Update Date: 02/15/2022
Certification Date: 02/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 LIBBEY INDUSTRIAL PARK
WEYMOUTH MA
02189-3129
US

IV. Provider business mailing address

DEPARTMENT 720 PO BOX 410
WOBURN MA
01888
US

V. Phone/Fax

Practice location:
  • Phone: 781-331-0537
  • Fax:
Mailing address:
  • Phone: 401-309-5975
  • 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: GARY T ROBELEN
Title or Position: AUTHORISED OFFICIAL
Credential: MD
Phone: 401-309-5975