Healthcare Provider Details

I. General information

NPI: 1558387738
Provider Name (Legal Business Name): HANOVER ANESTHESIA GROUP,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 12/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8260 ATLEE RD
MECHANICSVILLE VA
23116-1844
US

IV. Provider business mailing address

5855 BREMO RD SUITE 100
RICHMOND VA
23226-1926
US

V. Phone/Fax

Practice location:
  • Phone: 804-764-6000
  • Fax:
Mailing address:
  • Phone: 804-288-6258
  • Fax: 804-282-9921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. TESSA R LUDWIG
Title or Position: ADMINISTRATIVE ASSISTANT
Credential:
Phone: 804-288-4921