Provider Demographics
NPI:1730674532
Name:CHARTER ANESTHESIOLOGY LLC
Entity Type:Organization
Organization Name:CHARTER ANESTHESIOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:GIPSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-980-0368
Mailing Address - Street 1:151 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-9992
Mailing Address - Country:US
Mailing Address - Phone:203-980-0368
Mailing Address - Fax:
Practice Address - Street 1:1093 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-1104
Practice Address - Country:US
Practice Address - Phone:203-980-0368
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-25
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty