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General NPI Number Information
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NPI Number | 1598217911
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Entity Type | Organization
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Legal Business Name | ANESTHESIA PATIENT SERVICES OF VIRGINIA LLC
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Dates
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Enumeration Date | 11/02/2016
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Last Update Date | 11/02/2016
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Provider Practice Location Address
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Address Line | 200 MEDICAL PARK BLVD
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City | PETERSBURG
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State | VA
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Zip | 23805-9274
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Country | US
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Telephone | 516-945-3000
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Fax |
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Provider Business Mailing Address
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Address Line | 11781 LEE JACKSON MEMORIAL HWY
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City | FAIRFAX
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State | VA
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Zip | 22033-3309
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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 | MD
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Name | DR. JOHN DICAPUA
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Credential |
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Telephone | 516-945-3000
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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 | 0101249811
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License Number State | VA
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