Provider Demographics
NPI:1821535378
Name:NORTH SHORE AMBULATORY ANESTHESIA PARTNERS LLC
Entity Type:Organization
Organization Name:NORTH SHORE AMBULATORY ANESTHESIA PARTNERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:H
Authorized Official - Last Name:DOUGHERTY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-818-6500
Mailing Address - Street 1:1 ORTHOPEDICS DR
Mailing Address - Street 2:
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-1668
Mailing Address - Country:US
Mailing Address - Phone:877-868-6804
Mailing Address - Fax:
Practice Address - Street 1:1 ORTHOPEDICS DR
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-1668
Practice Address - Country:US
Practice Address - Phone:978-818-6500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-23
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAS100381573Medicare PIN