Healthcare Provider Details

I. General information

NPI: 1538135025
Provider Name (Legal Business Name): DALE J ROBERTSON CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 07/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 S STATE ST BAY ANESTHESIA ASSOCIATES
DOVER DE
19901-3530
US

IV. Provider business mailing address

PO BOX 10925 BAY ANESTHESIA ASSOCIATES
WILMINGTON DE
19850-0925
US

V. Phone/Fax

Practice location:
  • Phone: 302-674-4700
  • Fax:
Mailing address:
  • Phone: 302-674-4700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberL60A00462
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: