Healthcare Provider Details

I. General information

NPI: 1316051196
Provider Name (Legal Business Name): DELAWARE ANESTHESIA ASSOCIATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42084 STATE HIGHWAY 28
MARGARETVILLE NY
12455-2820
US

IV. Provider business mailing address

1780 COUNTY HIGHWAY 41
ROXBURY NY
12474-1408
US

V. Phone/Fax

Practice location:
  • Phone: 573-686-5550
  • Fax: 573-686-2139
Mailing address:
  • Phone: 573-686-5550
  • Fax: 573-686-2139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: VICTOR BARRACLOUGH
Title or Position: PRESIDENT
Credential: CRNA
Phone: 573-686-5550