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NPI Code Detail

MEDICARE: VISTA ANESTHESIA LLC

MEDICARE: VISTA ANESTHESIA LLC
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
1207L00000XAnesthesiology Physician

General Provider Information

NPI Number : 1780148080
Entity Type Code : Organization
Provider Name (Legal Business Name) : VISTA ANESTHESIA LLC
Provider Business Mailing Address
First Line : PO BOX 4307
Second Line :
City : UPPER MARLBORO
State : MD
Zip : 20775-0307
Country : US
Telephone Number : 908-653-9399
Fax Number :
Provider Business Practice Location Address
First Line : 25 COMMERCE DR STE 250
Second Line :
City : CRANFORD
State : NJ
Zip : 07016-3621
Country : US
Telephone Number : 908-653-9399
Fax Number :
Authorized Official
Title or Position : OWNER
Name : RAYMOND SMITH
Credential :
Telephone Number : 908-653-9399
Provider Enumeration Date : 01/31/2019
Last Update Date : 01/31/2019

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Directions to “VISTA ANESTHESIA LLC ” Practice Location

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