Healthcare Provider Details

I. General information

NPI: 1477652279
Provider Name (Legal Business Name): MOBILE ANESTHESIA SERVICE CONCEPTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9525 FRANKFORD AVENUE
PHILADELPHIA PA
19114
US

IV. Provider business mailing address

84 WOODHILL ROAD
NEWTOWN PA
18940
US

V. Phone/Fax

Practice location:
  • Phone: 215-333-9696
  • Fax: 215-333-8514
Mailing address:
  • Phone: 267-226-0050
  • Fax: 215-504-8334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberOS007111L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number StateNJ

VIII. Authorized Official

Name: DR. ANTHONY J. DEMARCO
Title or Position: PRESIDENT
Credential: DO
Phone: 267-226-0050