Healthcare Provider Details

I. General information

NPI: 1013196823
Provider Name (Legal Business Name): ROBERT A WORDEN CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2007
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 BROAD RD
SYRACUSE NY
13215-2265
US

IV. Provider business mailing address

PO BOX 2005
EAST SYRACUSE NY
13057-4505
US

V. Phone/Fax

Practice location:
  • Phone: 315-492-5522
  • Fax:
Mailing address:
  • Phone: 315-446-3904
  • Fax: 315-445-2936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number521697
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: