MEDICARE: SOUTHEAST ANESTHESIA ASSOC

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	207LP2900X	Pain Medicine (Anesthesiology) Physician
2	207L00000X	Anesthesiology Physician

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	:	1891780078
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHEAST ANESTHESIA ASSOC

Provider Business Mailing Address
First Line	:	340 MAIN ST
Second Line	:	STE. 670
City	:	WORCESTER
State	:	MA
Zip	:	01608-1604
Country	:	US
Telephone Number	:	508-754-3566
Fax Number	:	508-798-8012

Provider Business Practice Location Address
First Line	:	2100 DORCHESTER AVE
Second Line	:
City	:	DORCHESTER CENTER
State	:	MA
Zip	:	02124-5615
Country	:	US
Telephone Number	:	617-506-2027
Fax Number	:	617-474-3811

Authorized Official
Title or Position	:	VP/ADMINISTRATOR
Name	:	MR. PETER TREMLBAY
Credential	:
Telephone Number	:	617-506-2028

Provider Enumeration Date	:	09/14/2005
Last Update Date	:	04/06/2010

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Directions to “SOUTHEAST ANESTHESIA ASSOC ” Practice Location

Language	Start Address	Practice Location

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