Provider Demographics
NPI:1568280709
Name:VISIONARY ANESTHESIA, LLC
Entity type:Organization
Organization Name:VISIONARY ANESTHESIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL COUNSEL
Authorized Official - Prefix:MR
Authorized Official - First Name:EVAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:HAMMERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-833-3620
Mailing Address - Street 1:3206 TOWER OAKS BLVD STE 220
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4254
Mailing Address - Country:US
Mailing Address - Phone:240-833-3620
Mailing Address - Fax:
Practice Address - Street 1:210 MEADOWLANDS PKWY STE 5
Practice Address - Street 2:
Practice Address - City:SECAUCUS
Practice Address - State:NJ
Practice Address - Zip Code:07094-2306
Practice Address - Country:US
Practice Address - Phone:888-787-4379
Practice Address - Fax:877-821-8847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-27
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty