Provider Demographics
NPI:1851472054
Name:EAST COAST ANESTHESIA
Entity Type:Organization
Organization Name:EAST COAST ANESTHESIA
Other - Org Name:ARMEN KETCHEDJIAN, MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ARMEN
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:KETCHEDJIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-243-7686
Mailing Address - Street 1:PO BOX 547
Mailing Address - Street 2:
Mailing Address - City:SOUTHBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06488-0547
Mailing Address - Country:US
Mailing Address - Phone:203-243-7686
Mailing Address - Fax:
Practice Address - Street 1:929 BOSTON POST RD
Practice Address - Street 2:SUITE 1
Practice Address - City:OLD SAYBROOK
Practice Address - State:CT
Practice Address - Zip Code:06475-2143
Practice Address - Country:US
Practice Address - Phone:203-243-7686
Practice Address - Fax:
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
CT035600207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT2V5180OtherHEALTHNET INSURANCE
CTP2753812OtherOXFORD
CT500HBA454CT01OtherANTHEM BC/BS
CT2V5180OtherHEALTHNET INSURANCE