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General NPI Number Information
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NPI Number | 1639812134
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Entity Type | Individual
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Provider Name | ANDREW DEMAIO CRNA
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Gender | Male
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Dates
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Enumeration Date | 04/14/2022
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Last Update Date | 05/13/2022
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Provider Practice Location Address
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Address Line | 51 N 39TH ST
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City | PHILADELPHIA
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State | PA
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Zip | 19104-2640
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Country | US
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Telephone | 267-807-3250
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Fax |
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Provider Business Mailing Address
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Address Line | 1105 LINWOOD AVE
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City | HADDON TOWNSHIP
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State | NJ
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Zip | 08108-3351
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Country | US
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Telephone | 484-574-5352
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 141214
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License Number State | NJ
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