Healthcare Provider Details

I. General information

NPI: 1861450751
Provider Name (Legal Business Name): KEYSTONE ANESTHESIA CONSULTANTS, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 LANDINGS DR STE 202
WASHINGTON PA
15301-9408
US

IV. Provider business mailing address

2000 OXFORD DR SUITE 303
BETHEL PARK PA
15102-1827
US

V. Phone/Fax

Practice location:
  • Phone: 724-969-0191
  • Fax: 724-941-9089
Mailing address:
  • Phone: 412-942-5786
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMES MASSUCCI
Title or Position: PRESIDENT
Credential: M,D.
Phone: 412-942-5786