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General NPI Number Information
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NPI Number | 1003407164
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Entity Type | Organization
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Legal Business Name | TIDEWATER ANESTHESIA ASSOCIATES
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Dates
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Enumeration Date | 02/01/2021
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Last Update Date | 02/07/2025
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Provider Practice Location Address
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Address Line | 219 S WASHINGTON ST
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City | EASTON
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State | MD
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Zip | 21601-2913
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Country | US
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Telephone | 410-310-8576
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1208
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City | EASTON
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State | MD
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Zip | 21601-8924
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | BRADLEY A KLEINERT
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Credential | MD
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Telephone | 717-413-4756
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number |
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License Number State |
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