MEDICARE: EXCEL ANESTHESIA CONSULTANTS PLLC

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

General Provider Information

NPI Number	:	1407247463
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXCEL ANESTHESIA CONSULTANTS PLLC

Provider Business Mailing Address
First Line	:	334 GREENS EDGE DR
Second Line	:
City	:	CHESAPEAKE
State	:	VA
Zip	:	23322-8078
Country	:	US
Telephone Number	:	917-685-1055
Fax Number	:

Provider Business Practice Location Address
First Line	:	102 NORTHSIDE PARK
Second Line	:
City	:	ELIZABETH CTY
State	:	NC
Zip	:	27909-9337
Country	:	US
Telephone Number	:	917-685-1055
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. PRAVIN POTLURU
Credential	:
Telephone Number	:	917-685-1055

Provider Enumeration Date	:	02/12/2015
Last Update Date	:	02/12/2015

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