Provider Demographics
NPI:1619954815
Name:DELAWARE VALLEY ANESTHESIA ASSOCIATES, LLC
Entity Type:Organization
Organization Name:DELAWARE VALLEY ANESTHESIA ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:W
Authorized Official - Last Name:MCDOUGALL
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:856-358-4520
Mailing Address - Street 1:PO BOX 874
Mailing Address - Street 2:
Mailing Address - City:ELMER
Mailing Address - State:NJ
Mailing Address - Zip Code:08318-0874
Mailing Address - Country:US
Mailing Address - Phone:856-358-4520
Mailing Address - Fax:856-358-8053
Practice Address - Street 1:217 MADISON AVE
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NJ
Practice Address - Zip Code:08048-2901
Practice Address - Country:US
Practice Address - Phone:856-358-4520
Practice Address - Fax:856-358-8053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ041653367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty