Healthcare Provider Details

I. General information

NPI: 1114848587
Provider Name (Legal Business Name): ANEXA ANESTHESIA SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6020 MEADOWRIDGE CENTER DR
ELKRIDGE MD
21075-6528
US

IV. Provider business mailing address

2712 HEAVEN WOOD CT
ELLICOTT CITY MD
21042-2000
US

V. Phone/Fax

Practice location:
  • Phone: 443-275-7800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: GREGORY ROBERT DETORE
Title or Position: CEO
Credential: MD
Phone: 916-599-6337