Provider Demographics
NPI:1164474326
Name:PLATINUM ANESTHESIA PROFESSIONAL, P.C.
Entity Type:Organization
Organization Name:PLATINUM ANESTHESIA PROFESSIONAL, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:DIRENZO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:610-715-2837
Mailing Address - Street 1:1022 BAYBERRY LN
Mailing Address - Street 2:
Mailing Address - City:COLLEGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19426-3242
Mailing Address - Country:US
Mailing Address - Phone:610-715-2837
Mailing Address - Fax:
Practice Address - Street 1:1000 N BROAD ST
Practice Address - Street 2:
Practice Address - City:LANSDALE
Practice Address - State:PA
Practice Address - Zip Code:19446-1138
Practice Address - Country:US
Practice Address - Phone:610-715-2837
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty