Healthcare Provider Details

I. General information

NPI: 1235434903
Provider Name (Legal Business Name): RESOURCE ANESTHESIOLOGY ASSOCIATES OF OH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2011
Last Update Date: 01/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3654 WERK RD
CINCINNATI OH
45248-4900
US

IV. Provider business mailing address

10 COMMERCE DR
NEW ROCHELLE NY
10801-5253
US

V. Phone/Fax

Practice location:
  • Phone: 513-451-6001
  • Fax: 513-451-7310
Mailing address:
  • Phone: 914-637-3510
  • 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: MARC KOCH
Title or Position: CEO
Credential: MD
Phone: 914-637-3510