Healthcare Provider Details

I. General information

NPI: 1083784185
Provider Name (Legal Business Name): PHILADELPHIA ANESTHESIA GROUP, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 05/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 APPLETREE ST 7TH FLOOR
PHILADELPHIA PA
19106-1526
US

IV. Provider business mailing address

601 CHAPEL AVE E
CHERRY HILL NJ
08034-1454
US

V. Phone/Fax

Practice location:
  • Phone: 856-356-4000
  • Fax: 856-356-4038
Mailing address:
  • Phone: 856-356-4025
  • Fax: 856-356-4038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ANNE GRIFFIN
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 856-356-4025