Provider Demographics
NPI:1932152097
Name:MILFORD ANESTHESIA ASSOCIATES LLC
Entity Type:Organization
Organization Name:MILFORD ANESTHESIA ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KONDAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-838-2371
Mailing Address - Street 1:PO BOX 417297
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-7297
Mailing Address - Country:US
Mailing Address - Phone:954-838-2371
Mailing Address - Fax:913-242-6850
Practice Address - Street 1:831 BOSTON POST RD
Practice Address - Street 2:STE 201
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-3536
Practice Address - Country:US
Practice Address - Phone:203-876-5920
Practice Address - Fax:877-368-3377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207L00000X
CT367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0004078Medicare PIN
CTC01696Medicare PIN