Provider Demographics
NPI:1780683821
Name:DEARY, DANIEL J (CRNA)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:J
Last Name:DEARY
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Gender:M
Credentials:CRNA
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Mailing Address - Street 1:3998 FAIR RIDGE DR
Mailing Address - Street 2:SUITE 260
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-2907
Mailing Address - Country:US
Mailing Address - Phone:703-293-9590
Mailing Address - Fax:703-293-9592
Practice Address - Street 1:4320 SEMINARY RD
Practice Address - Street 2:INOVA ALEXANDRIA HOSPITAL
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-1535
Practice Address - Country:US
Practice Address - Phone:703-504-3789
Practice Address - Fax:703-504-3556
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2008-08-14
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Provider Licenses
StateLicense IDTaxonomies
VA0001150060163W00000X
VA0024166414367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC003372F89Medicare PIN