Organization
TIDEWATER ANESTHESIA ASSOCIATES, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRADLEY KLEINERT DO (PRESIDENT)
(717) 413-4756
Entity
Organization
Contact information
Practice address
219 S. WASHINGTON ST., EASTON, MD 21601-0712
(410) 822-1000
(410) 819-0712
Mailing address
PO BOX 1208, EASTON, MD 21601-8924
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
D0021319
MD
367500000X
Certified Registered Nurse Anesthetist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
155221000
—
MD
Enumeration date
06/01/2006
Last updated
02/14/2025
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