Provider Demographics
NPI:1679762801
Name:PGHC ANESTHESIA ASSOCIATES
Entity type:Organization
Organization Name:PGHC ANESTHESIA ASSOCIATES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:WALLINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-618-3655
Mailing Address - Street 1:3001 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:CHEVERLY
Mailing Address - State:MD
Mailing Address - Zip Code:20785-1189
Mailing Address - Country:US
Mailing Address - Phone:301-618-3655
Mailing Address - Fax:
Practice Address - Street 1:7300 VAN DUSEN RD
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-9463
Practice Address - Country:US
Practice Address - Phone:301-618-3655
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-24
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD024065Medicare PIN