Provider Demographics
NPI:1972521698
Name:POCONO ANESTHESIA ASSOCIATES,PC
Entity Type:Organization
Organization Name:POCONO ANESTHESIA ASSOCIATES,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:HAZLITT
Authorized Official - Last Name:DENCH
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:814-466-7975
Mailing Address - Street 1:PO BOX 580
Mailing Address - Street 2:
Mailing Address - City:BOALSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16827-0580
Mailing Address - Country:US
Mailing Address - Phone:814-466-7975
Mailing Address - Fax:814-466-7974
Practice Address - Street 1:945 OUTER DR
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-8236
Practice Address - Country:US
Practice Address - Phone:814-466-7975
Practice Address - Fax:814-466-7974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2008-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD033862L207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty