Provider Demographics
NPI:1114261567
Name:VERBOSH, ROBERT M (CRNA)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:M
Last Name:VERBOSH
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1245 S CEDAR CREST BLVD STE 301
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-6258
Mailing Address - Country:US
Mailing Address - Phone:610-402-8896
Mailing Address - Fax:610-402-9029
Practice Address - Street 1:1245 S CEDAR CREST BLVD STE 301
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-6258
Practice Address - Country:US
Practice Address - Phone:610-402-8896
Practice Address - Fax:610-402-9029
Is Sole Proprietor?:No
Enumeration Date:2012-11-23
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN-589691163W00000X
PA91548367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1615791OtherGATEWAY
PA12469304OtherCAQH
PA3889682000OtherIND. BLUE CROSS
PA9935980OtherAETNA
PA2753807OtherFIRST PRIORITY
PA1114261OtherGEISINGER
PA1114261567OtherHIGHMARK
PA1027794680001Medicaid
PA50112537OtherCAPITAL ADVANTAGE
PA262980QCYMedicare PIN