Provider Demographics
NPI:1497771380
Name:PENN VALLEY ANESTHESIA
Entity Type:Organization
Organization Name:PENN VALLEY ANESTHESIA
Other - Org Name:PENN VALLEY ANESTHESIA PROVIDERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:D
Authorized Official - Last Name:GELLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-358-4520
Mailing Address - Street 1:PO BOX 874
Mailing Address - Street 2:
Mailing Address - City:ELMER
Mailing Address - State:NJ
Mailing Address - Zip Code:08318-0874
Mailing Address - Country:US
Mailing Address - Phone:856-358-4520
Mailing Address - Fax:856-358-8053
Practice Address - Street 1:230 W WASHINGTON SQ
Practice Address - Street 2:4TH FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106-3500
Practice Address - Country:US
Practice Address - Phone:856-358-4520
Practice Address - Fax:856-358-8053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD026023E207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1741139OtherHIGHMARK BLUE SHIELD