Healthcare Provider Details

I. General information

NPI: 1609718105
Provider Name (Legal Business Name): AGELESS ANESTHESIA ASSOCIATES L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2026
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5361 GREENWICH CIR
UPPER MARLBORO MD
20772-4862
US

IV. Provider business mailing address

5361 GREENWICH CIR
UPPER MARLBORO MD
20772-4862
US

V. Phone/Fax

Practice location:
  • Phone: 504-202-7479
  • Fax:
Mailing address:
  • Phone: 504-202-7479
  • 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: ALEXIS J BENNETT
Title or Position: CEO
Credential: CRNA
Phone: 504-202-7479