Provider Demographics
NPI:1427032721
Name:ROTUNDA, DOLORES C (CRNA)
Entity Type:Individual
Prefix:
First Name:DOLORES
Middle Name:C
Last Name:ROTUNDA
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 GEIPE RD STE 201
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-4176
Mailing Address - Country:US
Mailing Address - Phone:102-477-5004
Mailing Address - Fax:410-737-6884
Practice Address - Street 1:700 GEIPE RD STE 230
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228
Practice Address - Country:US
Practice Address - Phone:410-247-7500
Practice Address - Fax:410-247-4227
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR114011367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD009138T34Medicare PIN