Healthcare Provider Details

I. General information

NPI: 1447526181
Provider Name (Legal Business Name): CHRISTOPHER MICHAEL MOLTION SRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2012
Last Update Date: 03/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 PROSPECT AVE ANESTHESIA DEPT.
SYRACUSE NY
13203-1807
US

IV. Provider business mailing address

2420 FILMORE AVE APT. 18
ERIE PA
16506-3051
US

V. Phone/Fax

Practice location:
  • Phone: 315-422-8608
  • Fax:
Mailing address:
  • Phone: 315-289-7497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number551491
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: