Healthcare Provider Details

I. General information

NPI: 1770538522
Provider Name (Legal Business Name): CHESHIRE ANESTHESIA ASSOCIATES, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 02/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

580 COURT ST ANESTHESIA DEPARTMENT
KEENE NH
03431-1718
US

IV. Provider business mailing address

PO BOX 845614
BOSTON MA
02284-5614
US

V. Phone/Fax

Practice location:
  • Phone: 603-354-5454
  • Fax: 603-354-5428
Mailing address:
  • Phone: 800-720-1664
  • Fax: 207-753-2020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN MARTY
Title or Position: MANAGING PARTNER
Credential: D.O.
Phone: 603-354-5454