Healthcare Provider Details

I. General information

NPI: 1003850546
Provider Name (Legal Business Name): MICHAEL FORD CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 03/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 LANSDOWNE AVE
DARBY PA
19023-1200
US

IV. Provider business mailing address

PO BOX 820137
PHILADELPHIA PA
19182-0137
US

V. Phone/Fax

Practice location:
  • Phone: 610-237-4500
  • Fax: 856-423-0823
Mailing address:
  • Phone: 610-270-2717
  • Fax: 610-270-2675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN504510L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: