Provider Demographics
NPI:1205886553
Name:KRIDLER, MARK J (CRNA)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:J
Last Name:KRIDLER
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:121 KILBUCK DR
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-4905
Mailing Address - Country:US
Mailing Address - Phone:412-953-1043
Mailing Address - Fax:412-374-9410
Practice Address - Street 1:516 PELLIS RD
Practice Address - Street 2:2020 SURGERY CENTER
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-4506
Practice Address - Country:US
Practice Address - Phone:724-836-1177
Practice Address - Fax:724-836-4700
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA211424L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAKR64644Medicare ID - Type Unspecified