Healthcare Provider Details

I. General information

NPI: 1831655521
Provider Name (Legal Business Name): MARK DEMSHICK CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2019
Last Update Date: 02/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

595 W STATE ST
DOYLESTOWN PA
18901-2554
US

IV. Provider business mailing address

595 W STATE ST
DOYLESTOWN PA
18901-2554
US

V. Phone/Fax

Practice location:
  • Phone: 215-345-2321
  • Fax: 517-787-7365
Mailing address:
  • Phone: 215-345-2321
  • Fax: 517-787-7365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN629539
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: