Provider Demographics
NPI:1841273869
Name:PROFESSIONAL ANESTHESIA CONSULTANTS, PC
Entity type:Organization
Organization Name:PROFESSIONAL ANESTHESIA CONSULTANTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:WALTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-986-8010
Mailing Address - Street 1:4330 E WEST HWY
Mailing Address - Street 2:SUITE 1100
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-4408
Mailing Address - Country:US
Mailing Address - Phone:301-986-8010
Mailing Address - Fax:301-986-8011
Practice Address - Street 1:4330 E WEST HWY
Practice Address - Street 2:SUITE 1100
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-4408
Practice Address - Country:US
Practice Address - Phone:301-986-8010
Practice Address - Fax:301-986-8011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-23
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA207L00000X
DEC1-0006506207L00000X
NJ25MA04290400207L00000X
PAMD043052E207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001859392-0002Medicaid
NJ8924309 & 8832005Medicaid
NJ051615Medicare ID - Type Unspecified
NJ8924309 & 8832005Medicaid
PA001859392-0002Medicaid