Healthcare Provider Details

I. General information

NPI: 1962653188
Provider Name (Legal Business Name): EAST COAST ANESTHESIA INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2008
Last Update Date: 10/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3231 HUNTERSWORTH WAY
GLENWOOD MD
21738
US

IV. Provider business mailing address

3231 HUNTERSWORTH WAY
GLENWOOD MD
21738
US

V. Phone/Fax

Practice location:
  • Phone: 443-350-0111
  • Fax:
Mailing address:
  • Phone: 443-350-0111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. RICHARD ALAN PIPPENGER JR.
Title or Position: PRESIDENT
Credential: CRNA
Phone: 443-350-0111