Provider Demographics
NPI:1891748075
Name:DOSHER ANESTHESIA PLLC
Entity Type:Organization
Organization Name:DOSHER ANESTHESIA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORGANIZING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KAMI
Authorized Official - Middle Name:K
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-754-6126
Mailing Address - Street 1:1620 GOLEY HEWETT RD SE
Mailing Address - Street 2:UNIT 304
Mailing Address - City:BOLIVIA
Mailing Address - State:NC
Mailing Address - Zip Code:28422-8092
Mailing Address - Country:US
Mailing Address - Phone:910-754-6126
Mailing Address - Fax:
Practice Address - Street 1:924 N HOWE ST
Practice Address - Street 2:
Practice Address - City:SOUTHPORT
Practice Address - State:NC
Practice Address - Zip Code:28461-3038
Practice Address - Country:US
Practice Address - Phone:910-457-3800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5903344Medicaid