Provider Demographics
NPI:1720223209
Name:SPECTRUM ANESTHESIA SERVICES LLC
Entity Type:Organization
Organization Name:SPECTRUM ANESTHESIA SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BILLING
Authorized Official - Prefix:
Authorized Official - First Name:NINA
Authorized Official - Middle Name:
Authorized Official - Last Name:DUGGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-295-9360
Mailing Address - Street 1:PO BOX 37158
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21297-3158
Mailing Address - Country:US
Mailing Address - Phone:703-295-9360
Mailing Address - Fax:703-295-9369
Practice Address - Street 1:6802 PARAGON PL
Practice Address - Street 2:SUITE 410
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-1644
Practice Address - Country:US
Practice Address - Phone:703-295-9360
Practice Address - Fax:703-295-9369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-11
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty