Provider Demographics
NPI:1255888269
Name:OPTIMAL ANESTHESIA LLC
Entity type:Organization
Organization Name:OPTIMAL ANESTHESIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:W
Authorized Official - Last Name:KOSSOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-775-7733
Mailing Address - Street 1:PO BOX 1973
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-0973
Mailing Address - Country:US
Mailing Address - Phone:941-360-1566
Mailing Address - Fax:
Practice Address - Street 1:70 THOMAS JOHNSON DR STE 120
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4317
Practice Address - Country:US
Practice Address - Phone:301-624-5566
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-07
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty