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General NPI Number Information
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NPI Number | 1184730129
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Entity Type | Organization
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Legal Business Name | LAUREL GROUP ANESTHESIA PC
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Dates
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Enumeration Date | 08/22/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1086 FRANKLIN ST SUITE M4000
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City | JOHNSTOWN
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State | PA
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Zip | 15905-4305
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Country | US
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Telephone | 814-534-9102
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Fax |
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Provider Business Mailing Address
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Address Line | 1086 FRANKLIN ST SUITE M4000
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City | JOHNSTOWN
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State | PA
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Zip | 15905-4305
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Country | US
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Telephone | 814-534-9102
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Fax |
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Authorized Official
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Title or Position | INCORPORATOR
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Name | JASMAT KANSAGRA
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Credential | MD
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Telephone | 814-534-9323
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | MD044818E
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License Number State | PA
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