Healthcare Provider Details

I. General information

NPI: 1619954815
Provider Name (Legal Business Name): DELAWARE VALLEY ANESTHESIA ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 MADISON AVE
LUMBERTON NJ
08048-2901
US

IV. Provider business mailing address

PO BOX 874
ELMER NJ
08318-0874
US

V. Phone/Fax

Practice location:
  • Phone: 856-358-4520
  • Fax: 856-358-8053
Mailing address:
  • Phone: 856-358-4520
  • Fax: 856-358-8053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number041653
License Number StateNJ

VIII. Authorized Official

Name: ROBERT W MCDOUGALL
Title or Position: CEO/MEMBER
Credential: CRNA
Phone: 856-358-4520