Provider Demographics
NPI:1265465751
Name:PROFESSIONAL ANESTHESIA ASSOCIATES, INC
Entity Type:Organization
Organization Name:PROFESSIONAL ANESTHESIA ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:J
Authorized Official - Last Name:ANTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-282-4022
Mailing Address - Street 1:111 FOUNDERS PLZ
Mailing Address - Street 2:#300 C/O IPMS
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06108-3212
Mailing Address - Country:US
Mailing Address - Phone:860-282-4022
Mailing Address - Fax:860-282-0834
Practice Address - Street 1:111 FOUNDERS PLZ
Practice Address - Street 2:#300 C/O IPMS
Practice Address - City:EAST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06108-3212
Practice Address - Country:US
Practice Address - Phone:860-282-4022
Practice Address - Fax:860-282-0834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001158642Medicaid
B76574Medicare UPIN
CT001158642Medicaid