Healthcare Provider Details

I. General information

NPI: 1780854828
Provider Name (Legal Business Name): EDWARD SLADE ROGERSON CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2008
Last Update Date: 03/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5855 BREMO RD SUITE 100 NORTH
RICHMOND VA
23226-1930
US

IV. Provider business mailing address

5855 BREMO RD SUITE 100 NORTH
RICHMOND VA
23226-1930
US

V. Phone/Fax

Practice location:
  • Phone: 804-288-6258
  • Fax: 804-282-9921
Mailing address:
  • Phone: 804-288-6258
  • Fax: 804-282-9921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0024167683
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: