MEDICARE: BRUCE DELARSO CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	26NR09989700	NJ
2	367500000X	Certified Registered Nurse Anesthetist	RN322809L	PA
3	367500000X	Certified Registered Nurse Anesthetist	26NJ00282500	NJ

General Provider Information

NPI Number	:	1851397699
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRUCE DELARSO CRNA

Provider Business Mailing Address
First Line	:	20 NORMANDY RD
Second Line	:
City	:	MARLTON
State	:	NJ
Zip	:	08053
Country	:	US
Telephone Number	:	856-810-1133
Fax Number	:

Provider Business Practice Location Address
First Line	:	90 BRICK RD FL GROUND
Second Line	:
City	:	MARLTON
State	:	NJ
Zip	:	08053-2177
Country	:	US
Telephone Number	:	856-988-6260
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2005
Last Update Date	:	08/21/2024

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Directions to “ BRUCE DELARSO CRNA” Practice Location

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