Provider Demographics
NPI:1982672044
Name:COLUMBIA ANESTHESIA ASSOCIATES
Entity Type:Organization
Organization Name:COLUMBIA ANESTHESIA ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ANANDA
Authorized Official - Middle Name:K
Authorized Official - Last Name:PANIKKAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-784-6118
Mailing Address - Street 1:38 MILLERTOWN RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17815-7103
Mailing Address - Country:US
Mailing Address - Phone:570-784-6118
Mailing Address - Fax:570-784-7046
Practice Address - Street 1:549 FAIR ST
Practice Address - Street 2:
Practice Address - City:BLOOMSBURG
Practice Address - State:PA
Practice Address - Zip Code:17815-1419
Practice Address - Country:US
Practice Address - Phone:570-784-6118
Practice Address - Fax:570-784-7046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-14
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
PA1014361470001Medicaid
PA1014361470001Medicaid