Healthcare Provider Details

I. General information

NPI: 1427029917
Provider Name (Legal Business Name): RAYMOND JOHN LINDSAY CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2006
Last Update Date: 06/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 LEE ST
CHARLOTTESVILLE VA
22908-0816
US

IV. Provider business mailing address

PO BOX 800778
CHARLOTTESVILLE VA
22908-0778
US

V. Phone/Fax

Practice location:
  • Phone: 434-924-0000
  • Fax:
Mailing address:
  • Phone: 434-982-4228
  • Fax: 434-924-2078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0024164206
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: