Basic Information
| Provider Information | |||||||||
| NPI: | 1700061652 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ATLANTIC ANESTHESIA, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 96 | ||||||||
| Address2: | |||||||||
| City: | LEWISTON | ||||||||
| State: | ME | ||||||||
| PostalCode: | 042430096 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8007201664 | ||||||||
| FaxNumber: | 2077532020 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 MORSE ST | ||||||||
| Address2: | EASTERN MASSACHUSETTS SURGERY CENTER | ||||||||
| City: | NORWOOD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 020624679 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6174809060 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/09/2008 | ||||||||
| LastUpdateDate: | 01/09/2008 | ||||||||
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| AuthorizedOfficialLastName: | AL-TABBAA | ||||||||
| AuthorizedOfficialFirstName: | AMER | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6174809060 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.