Provider Demographics
NPI:1477641405
Name:DAGGAN, RALPH N III (CRNA)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:N
Last Name:DAGGAN
Suffix:III
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 1:1 FEDERAL ST
Mailing Address - Street 2:STE SW200
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1155
Mailing Address - Country:US
Mailing Address - Phone:856-382-6530
Mailing Address - Fax:856-968-8499
Practice Address - Street 1:1 COOPER PLZ
Practice Address - Street 2:DEPT OF ANESTHEISA
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-1461
Practice Address - Country:US
Practice Address - Phone:856-342-2425
Practice Address - Fax:856-968-8239
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNO07823500367500000X
PARN272385L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ010007379OtherAMERICHOICE
R83215Medicare UPIN
NJ597438 CK2Medicare PIN