Provider Demographics
NPI:1205827359
Name:RIVERSIDE ANESTHESIA ASSOCIATES, LTD
Entity Type:Organization
Organization Name:RIVERSIDE ANESTHESIA ASSOCIATES, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:C
Authorized Official - Last Name:KEYSER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-545-5256
Mailing Address - Street 1:1 RUTHERFORD ROAD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17109
Mailing Address - Country:US
Mailing Address - Phone:717-545-5256
Mailing Address - Fax:717-545-5259
Practice Address - Street 1:1 RUTHERFORD ROAD
Practice Address - Street 2:SUITE 101
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17109
Practice Address - Country:US
Practice Address - Phone:717-545-5256
Practice Address - Fax:717-545-5259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010985840019Medicaid
PA071168Medicare PIN