Healthcare Provider Details

I. General information

NPI: 1518902071
Provider Name (Legal Business Name): ANESTHESIOLOGISTS OF ERIE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 11/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 STATE ST
ERIE PA
16550-0002
US

IV. Provider business mailing address

PO BOX 6490
ERIE PA
16512-6490
US

V. Phone/Fax

Practice location:
  • Phone: 814-877-2137
  • Fax: 814-877-7049
Mailing address:
  • Phone: 814-480-8732
  • Fax: 814-456-5524

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KEVIN NOVAK
Title or Position: ANESTHESIOLOGIST
Credential: MD
Phone: 814-877-2137