Provider Demographics
NPI:1497835912
Name:MID COAST ANESTHESIA, PA
Entity Type:Organization
Organization Name:MID COAST ANESTHESIA, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IRL
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROSNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:207-373-1025
Mailing Address - Street 1:121 MEDICAL CENTER DR
Mailing Address - Street 2:BOX 6
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-2653
Mailing Address - Country:US
Mailing Address - Phone:207-373-1025
Mailing Address - Fax:207-373-1025
Practice Address - Street 1:123 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-2652
Practice Address - Country:US
Practice Address - Phone:207-373-1025
Practice Address - Fax:207-373-1026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Not Answered207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME4546191OtherAETNA
ME=========001OtherANTHEM BLUE CROSS
MEMM4065Medicare ID - Type Unspecified