Provider Demographics
NPI:1720471071
Name:CAP ANESTHESIA, PC
Entity Type:Organization
Organization Name:CAP ANESTHESIA, PC
Other - Org Name:TANAGRAM HEALTH, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:T
Authorized Official - Last Name:ROBELEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-789-2797
Mailing Address - Street 1:77 WARREN ST
Mailing Address - Street 2:BRIGHTON MARINE HEALTH CTR, INC - BLDG 2
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-3601
Mailing Address - Country:US
Mailing Address - Phone:617-789-2797
Mailing Address - Fax:617-254-6384
Practice Address - Street 1:77 WARREN ST
Practice Address - Street 2:BRIGHTON MARINE HEALTH CTR, INC - BLDG 2
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-3601
Practice Address - Country:US
Practice Address - Phone:617-789-2797
Practice Address - Fax:617-254-6384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-11
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center