Healthcare Provider Details

I. General information

NPI: 1235545666
Provider Name (Legal Business Name): ANTHRACITE ANESTHESIA ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2014
Last Update Date: 07/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 GALLAGHER DR
PLAINS PA
18705-1146
US

IV. Provider business mailing address

6 ANDOVER RD
MOUNTAIN TOP PA
18707-2262
US

V. Phone/Fax

Practice location:
  • Phone: 570-970-1030
  • Fax: 570-970-0511
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL DOPKO
Title or Position: AUTHORIZED OFFICIAL
Credential: CRNA
Phone: 570-970-1030