Provider Demographics
NPI:1134144314
Name:BOUCOT, DANIEL WILLIAM (CRNA)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:WILLIAM
Last Name:BOUCOT
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:700 US 130 N SUITE 203
Mailing Address - Street 2:RANCOCAS ANESTHESIOLOGY, P.A.
Mailing Address - City:CINNAMINSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08077
Mailing Address - Country:US
Mailing Address - Phone:856-829-9345
Mailing Address - Fax:856-829-3605
Practice Address - Street 1:2201 CHAPEL AVE
Practice Address - Street 2:.KENNEDY HEALTH SYSTEM
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08002
Practice Address - Country:US
Practice Address - Phone:856-829-9345
Practice Address - Fax:856-829-3605
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2008-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NO10306600367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ043035Medicare PIN