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NPI Code Detail

MEDICARE: MR. GERALD L ALCANTARA CRNA

MEDICARE: MR. GERALD L ALCANTARA 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
1163W00000XRegistered Nurse0001156458VA
2367500000XCertified Registered Nurse Anesthetist0024156458VA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2990014002OTHERRAILROAD MEDICARE

Other Identifiers

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

General Provider Information

NPI Number : 1912983214
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. GERALD L ALCANTARA CRNA
Provider Business Mailing Address
First Line : 3100 SPRING FOREST RD
Second Line : SUITE 130
City : RALEIGH
State : NC
Zip : 27616-2880
Country : US
Telephone Number : 919-882-0705
Fax Number : 919-873-9821
Provider Business Practice Location Address
First Line : 44045 RIVERSIDE PKWY
Second Line :
City : LEESBURG
State : VA
Zip : 20176-5101
Country : US
Telephone Number : 703-858-6000
Fax Number : 571-209-6465
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/19/2005
Last Update Date : 09/30/2013

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