Healthcare Provider Details

I. General information

NPI: 1619943107
Provider Name (Legal Business Name): DANIEL T. DOLT C.R.N.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 05/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 S STATE ST BAYHEALTH MEDICAL CENTER, DEPT. OF ANESTHESIA
DOVER DE
19901-3530
US

IV. Provider business mailing address

61 WENTWORTH WAY
MAGNOLIA DE
19962-1652
US

V. Phone/Fax

Practice location:
  • Phone: 302-744-7089
  • Fax:
Mailing address:
  • Phone: 215-520-3605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberL60A00409
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: