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General NPI Number Information
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NPI Number | 1679839062
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Entity Type | Organization
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Legal Business Name | MID-ATLANTIC ANESTHESIA CONSULTANTS
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Dates
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Enumeration Date | 04/10/2012
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Last Update Date | 04/10/2012
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Provider Practice Location Address
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Address Line | 254 SW HARBOR VIEW DR.
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City | PALM CITY
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State | FL
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Zip | 14990
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Country | US
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Telephone | 772-215-5905
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Fax |
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Provider Business Mailing Address
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Address Line | 254 SW HARBOR VIEW DR.
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City | PALM CITY
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State | FL
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Zip | 14990
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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 | CARL GITTENS
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Credential | M.D.
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Telephone | 772-215-5905
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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 | ME53378
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License Number State | FL
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