Healthcare Provider Details

I. General information

NPI: 1982675948
Provider Name (Legal Business Name): DEAN PAUL CARY CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 12/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6900 GEORGIA AVE NW
WASHINGTON DC
20307-0003
US

IV. Provider business mailing address

19203 CROSS RIDGE DR
GERMANTOWN MD
20874-1595
US

V. Phone/Fax

Practice location:
  • Phone: 202-782-7712
  • Fax:
Mailing address:
  • Phone: 301-540-2224
  • Fax: 301-540-6453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR116470
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: