Healthcare Provider Details

I. General information

NPI: 1124013693
Provider Name (Legal Business Name): HAVERFORD ANESTHESIA ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2010 OLD WEST CHESTER PIKE SUITE 330
HAVERTOWN PA
19083
US

IV. Provider business mailing address

PO BOX 8500-4066
PHILADELPHIA PA
19178-0001
US

V. Phone/Fax

Practice location:
  • Phone: 610-789-8070
  • Fax: 302-733-0854
Mailing address:
  • Phone: 302-733-0806
  • Fax: 302-733-0854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number StatePA

VIII. Authorized Official

Name: WILLIAM GOLDSTEIN
Title or Position: ANESTHESIOLOGIST
Credential: MD
Phone: 610-789-8070