Healthcare Provider Details

I. General information

NPI: 1003898735
Provider Name (Legal Business Name): ROBERT MERRITT CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2005
Last Update Date: 02/11/2020
Certification Date: 02/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 MONUMENT RD STE 270
YORK PA
17403
US

IV. Provider business mailing address

PO BOX 783497
PHILADELPHIA PA
19178-3497
US

V. Phone/Fax

Practice location:
  • Phone: 717-741-8250
  • Fax: 717-741-8289
Mailing address:
  • Phone: 610-395-4044
  • Fax: 610-395-5693

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN244350L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: