Healthcare Provider Details

I. General information

NPI: 1255888269
Provider Name (Legal Business Name): OPTIMAL ANESTHESIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2016
Last Update Date: 01/21/2021
Certification Date: 01/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 THOMAS JOHNSON DR STE 120
FREDERICK MD
21702-4317
US

IV. Provider business mailing address

PO BOX 1973
FREDERICK MD
21702-0973
US

V. Phone/Fax

Practice location:
  • Phone: 301-624-5566
  • Fax:
Mailing address:
  • Phone: 941-360-1566
  • 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: DAVID W KOSSOFF
Title or Position: MD/MEMBER
Credential:
Phone: 301-775-7733