Provider Demographics
NPI:1306817853
Name:MALDOVAN, DANIEL R (CRNA)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:R
Last Name:MALDOVAN
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 1:12941 STONECREEK DR
Mailing Address - Street 2:UNIT A
Mailing Address - City:PICKERINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43147-8424
Mailing Address - Country:US
Mailing Address - Phone:614-552-0061
Mailing Address - Fax:614-552-0168
Practice Address - Street 1:6001 E BROAD ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-1502
Practice Address - Country:US
Practice Address - Phone:614-552-0061
Practice Address - Fax:614-552-0168
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNA-41068367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2018051Medicaid
OH2018051Medicaid