MEDICARE: ANESTHESIA SPECIALISTS, PTR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	168544-R	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013910330
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANESTHESIA SPECIALISTS, PTR

Provider Business Mailing Address
First Line	:	PO BOX 79446
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21279-0446
Country	:	US
Telephone Number	:	757-567-8832
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 E MAIN ST STE 1300
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23510-1756
Country	:	US
Telephone Number	:	757-388-3000
Fax Number	:

Authorized Official
Title or Position	:	PRACTICE ADMINISTRATOR
Name	:	NICOLE J. WOOD-SABO
Credential	:
Telephone Number	:	757-567-8832

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	08/18/2023

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