Healthcare Provider Details

I. General information

NPI: 1477641405
Provider Name (Legal Business Name): RALPH N DAGGAN III CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 04/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 COOPER PLZ DEPT OF ANESTHEISA
CAMDEN NJ
08103-1461
US

IV. Provider business mailing address

1 FEDERAL ST STE SW200
CAMDEN NJ
08103-1155
US

V. Phone/Fax

Practice location:
  • Phone: 856-342-2425
  • Fax: 856-968-8239
Mailing address:
  • Phone: 856-382-6530
  • Fax: 856-968-8499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberNO07823500
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN272385L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: