Provider Demographics
NPI:1467775692
Name:DELGROSSO, BRIAN MICHAEL (CRNA)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:MICHAEL
Last Name:DELGROSSO
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Gender:M
Credentials:CRNA
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Mailing Address - Street 1:PO BOX 32861
Mailing Address - Street 2:ANESTHESIA SERVICES 5TH FLOOR SURGICAL TOWER
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28232-2861
Mailing Address - Country:US
Mailing Address - Phone:704-355-8983
Mailing Address - Fax:704-355-8994
Practice Address - Street 1:1000 BLYTHE BLVD
Practice Address - Street 2:ANESTHESIA SERVICES 5TH FLOOR SURGICAL TOWER
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-5812
Practice Address - Country:US
Practice Address - Phone:704-355-8983
Practice Address - Fax:704-355-8994
Is Sole Proprietor?:No
Enumeration Date:2010-03-02
Last Update Date:2011-12-23
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Provider Licenses
StateLicense IDTaxonomies
NC91390367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2618368Medicare PIN