Basic Information
| Provider Information | |||||||||
| NPI: | 1497763213 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CAP ANESTHESIA, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3636 | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 022413636 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7814077713 | ||||||||
| FaxNumber: | 7814070998 | ||||||||
| Practice Location | |||||||||
| Address1: | 61 SUNSET RD | ||||||||
| Address2: | |||||||||
| City: | WESTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024931636 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7817109857 | ||||||||
| FaxNumber: | 4137967498 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2006 | ||||||||
| LastUpdateDate: | 09/30/2021 | ||||||||
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| AuthorizedOfficialLastName: | ROBELEN | ||||||||
| AuthorizedOfficialFirstName: | GARY | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6177892782 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 09/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208VP0014X | MA | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine | 207L00000X | MA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 9757121 | 05 | MA | MEDICAID |