Healthcare Provider Details

I. General information

NPI: 1275863623
Provider Name (Legal Business Name): EDWARD L PIEPER IV CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2010
Last Update Date: 06/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2209 GENESEE ST
UTICA NY
13501-5999
US

IV. Provider business mailing address

2209 GENESEE STREET BUSINESS OFFICE ROOM 315
UTICA NY
13501-5930
US

V. Phone/Fax

Practice location:
  • Phone: 315-801-3329
  • Fax: 315-801-3072
Mailing address:
  • Phone: 315-801-3282
  • Fax: 315-801-8391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number561255
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN2278195
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number101.0083675
License Number StateVT
# 4
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number561255-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: