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General NPI Number Information
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NPI Number | 1114848587
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Entity Type | Organization
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Legal Business Name | ANEXA ANESTHESIA SERVICES, LLC
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Dates
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Enumeration Date | 07/22/2026
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Last Update Date | 07/22/2026
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Provider Practice Location Address
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Address Line | 6020 MEADOWRIDGE CENTER DR
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City | ELKRIDGE
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State | MD
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Zip | 21075-6528
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Country | US
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Telephone | 443-275-7800
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Fax |
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Provider Business Mailing Address
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Address Line | 2712 HEAVEN WOOD CT
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City | ELLICOTT CITY
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State | MD
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Zip | 21042-2000
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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 | CEO
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Name | GREGORY ROBERT DETORE
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Credential | MD
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Telephone | 916-599-6337
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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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