Provider Demographics
NPI:1477728897
Name:LEAR ANESTHESIA SERVICES LLC
Entity Type:Organization
Organization Name:LEAR ANESTHESIA SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DESTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-288-4669
Mailing Address - Street 1:7702 LEAR RD
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-2734
Mailing Address - Country:US
Mailing Address - Phone:703-288-4669
Mailing Address - Fax:703-288-4669
Practice Address - Street 1:2440 M ST NW
Practice Address - Street 2:SUITE 401
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-1404
Practice Address - Country:US
Practice Address - Phone:202-293-6567
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-26
Last Update Date:2008-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD30939261QA0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0006XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Fertility Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC034597900Medicaid
DCH68722Medicare UPIN