Healthcare Provider Details

I. General information

NPI: 1558460196
Provider Name (Legal Business Name): ATLANTIC ANESTHESIA, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 11/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 MARSH BROOK DR SUITE 10
SOMERSWORTH NH
03878-6523
US

IV. Provider business mailing address

3998 FAIR RIDGE DR. SUITE 300
FAIRFAX VA
22033-2921
US

V. Phone/Fax

Practice location:
  • Phone: 315-413-5229
  • Fax: 603-953-0005
Mailing address:
  • Phone: 603-249-7246
  • Fax: 603-953-0005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DALE ANDERSON
Title or Position: MANAGING PARTNER-REGIONAL DIRECTOR
Credential: M.D.
Phone: 703-766-9737