Provider Demographics
NPI:1275863623
Name:PIEPER, EDWARD L IV (CRNA)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:L
Last Name:PIEPER
Suffix:IV
Gender:M
Credentials:CRNA
Other - Prefix:
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Mailing Address - Street 1:2209 GENESEE STREET
Mailing Address - Street 2:BUSINESS OFFICE ROOM 315
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13501-5930
Mailing Address - Country:US
Mailing Address - Phone:315-801-3282
Mailing Address - Fax:315-801-8391
Practice Address - Street 1:2209 GENESEE ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13501-5999
Practice Address - Country:US
Practice Address - Phone:315-801-3329
Practice Address - Fax:315-801-3072
Is Sole Proprietor?:No
Enumeration Date:2010-01-07
Last Update Date:2019-06-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY561255367500000X
MARN2278195367500000X
VT101.0083675367500000X
NY561255-1367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered