Provider Demographics
NPI:1942218821
Name:MIDDLETOWN ANESTHESIA GROUP PC
Entity Type:Organization
Organization Name:MIDDLETOWN ANESTHESIA GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERICH
Authorized Official - Middle Name:A
Authorized Official - Last Name:EVERTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-710-2196
Mailing Address - Street 1:1205 LANGHORNE NEWTOWN RD
Mailing Address - Street 2:
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-1219
Mailing Address - Country:US
Mailing Address - Phone:215-710-2196
Mailing Address - Fax:
Practice Address - Street 1:1205 LANGHORNE NEWTOWN RD
Practice Address - Street 2:
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-1219
Practice Address - Country:US
Practice Address - Phone:215-710-2196
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011041440008Medicaid
PA180502Medicare PIN