Provider Demographics
NPI:1346396603
Name:MASSACHUSETTS ANESTHESIA CORPORATION
Entity Type:Organization
Organization Name:MASSACHUSETTS ANESTHESIA CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:DENEKAMP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-341-3966
Mailing Address - Street 1:255 PLAIN DR
Mailing Address - Street 2:
Mailing Address - City:STOUGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02072-3962
Mailing Address - Country:US
Mailing Address - Phone:781-341-3966
Mailing Address - Fax:
Practice Address - Street 1:255 PLAIN DR
Practice Address - Street 2:
Practice Address - City:STOUGHTON
Practice Address - State:MA
Practice Address - Zip Code:02072-3962
Practice Address - Country:US
Practice Address - Phone:781-341-3966
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9785051Medicaid
MAM17166OtherMA BLUE SHIELD
MAM17166OtherMA BLUE SHIELD