Healthcare Provider Details

I. General information

NPI: 1780061754
Provider Name (Legal Business Name): JAMES LUTHER PUGH JR. CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2015
Last Update Date: 04/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4755 OGLETOWN STANTON ROAD
NEWARK DE
19718-1320
US

IV. Provider business mailing address

2 READS WAY STE. 201
NEW CASTLE DE
19720-1630
US

V. Phone/Fax

Practice location:
  • Phone: 302-733-1000
  • Fax: 302-733-2685
Mailing address:
  • Phone: 302-709-4709
  • Fax: 302-709-4551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number103052
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberL1-0034009
License Number StateDE
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number26NR15684500
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN535061
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: