Provider Demographics
NPI:1346240090
Name:JEANNETTE ANESTHESIA GROUP, PC
Entity Type:Organization
Organization Name:JEANNETTE ANESTHESIA GROUP, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MANDIGA
Authorized Official - Middle Name:V
Authorized Official - Last Name:RAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-527-6517
Mailing Address - Street 1:PO BOX 155
Mailing Address - Street 2:
Mailing Address - City:GRAPEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15634-0155
Mailing Address - Country:US
Mailing Address - Phone:724-527-6517
Mailing Address - Fax:724-527-6519
Practice Address - Street 1:600 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:JEANNETTE
Practice Address - State:PA
Practice Address - Zip Code:15644-2505
Practice Address - Country:US
Practice Address - Phone:724-527-3551
Practice Address - Fax:724-527-6519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G1430OtherRR/MED
PA0017544610002Medicaid
PA28813Medicare ID - Type Unspecified