Provider Demographics
NPI:1558460196
Name:ATLANTIC ANESTHESIA, PA
Entity Type:Organization
Organization Name:ATLANTIC ANESTHESIA, PA
Other - Org Name:SEACOAST PAIN INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER-REGIONAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DALE
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-766-9737
Mailing Address - Street 1:3998 FAIR RIDGE DR.
Mailing Address - Street 2:SUITE 300
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-2921
Mailing Address - Country:US
Mailing Address - Phone:603-249-7246
Mailing Address - Fax:603-953-0005
Practice Address - Street 1:7 MARSH BROOK DR
Practice Address - Street 2:SUITE 10
Practice Address - City:SOMERSWORTH
Practice Address - State:NH
Practice Address - Zip Code:03878-6523
Practice Address - Country:US
Practice Address - Phone:315-413-5229
Practice Address - Fax:603-953-0005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH80000007Medicaid
NT0007Medicare ID - Type Unspecified