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General NPI Number Information
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NPI Number | 1851472054
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Entity Type | Organization
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Legal Business Name | EAST COAST ANESTHESIA
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Dates
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Enumeration Date | 10/17/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 929 BOSTON POST RD SUITE 1
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City | OLD SAYBROOK
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State | CT
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Zip | 06475-2143
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Country | US
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Telephone | 203-243-7686
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 547
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City | SOUTHBURY
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State | CT
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Zip | 06488-0547
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Country | US
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Telephone | 203-243-7686
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN/PRESIDENT
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Name | DR. ARMEN GREGORY KETCHEDJIAN
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Credential | MD
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Telephone | 203-243-7686
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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 | 035600
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License Number State | CT
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