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NPI Code Detail

MEDICARE: SALVATORE E BOLOGNA CRNA

MEDICARE:   SALVATORE E BOLOGNA  CRNA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1367500000XCertified Registered Nurse AnesthetistARNP1303222FL
2367500000XCertified Registered Nurse Anesthetist313410NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P00646402OTHERFLRAILROAD MEIDCARE
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1164529129
Entity Type Code : Individual
Provider Name (Legal Business Name) : SALVATORE E BOLOGNA CRNA
Provider Business Mailing Address
First Line : PO BOX 410944
Second Line :
City : MELBOURNE
State : FL
Zip : 32941-0944
Country : US
Telephone Number : 561-762-2823
Fax Number :
Provider Business Practice Location Address
First Line : 736 IRVING AVE
Second Line :
City : SYRACUSE
State : NY
Zip : 13210-1602
Country : US
Telephone Number : 315-470-7111
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2006
Last Update Date : 04/25/2024

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Directions to “ SALVATORE E BOLOGNA CRNA” Practice Location

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