Provider Demographics
NPI:1407247463
Name:EXCEL ANESTHESIA CONSULTANTS PLLC
Entity Type:Organization
Organization Name:EXCEL ANESTHESIA CONSULTANTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PRAVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:POTLURU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-685-1055
Mailing Address - Street 1:334 GREENS EDGE DR
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23322-8078
Mailing Address - Country:US
Mailing Address - Phone:917-685-1055
Mailing Address - Fax:
Practice Address - Street 1:102 NORTHSIDE PARK
Practice Address - Street 2:
Practice Address - City:ELIZABETH CTY
Practice Address - State:NC
Practice Address - Zip Code:27909-9337
Practice Address - Country:US
Practice Address - Phone:917-685-1055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-12
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty