Healthcare Provider Details

I. General information

NPI: 1134100449
Provider Name (Legal Business Name): ANESTHESIOLOGICAL GROUP OF NEPA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1822 MULBERRY ST
SCRANTON PA
18510-2369
US

IV. Provider business mailing address

PO BOX 390
SCRANTON PA
18501-0390
US

V. Phone/Fax

Practice location:
  • Phone: 570-346-7797
  • Fax: 570-342-9802
Mailing address:
  • Phone: 570-346-7797
  • Fax: 570-342-9802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0015083230004
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: KISHOR VEKARIA
Title or Position: HEAD OF GROUP
Credential: MD
Phone: 570-346-7797