Provider Demographics
NPI:1295953578
Name:RATHBUN, DAVID L (CRNA)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:L
Last Name:RATHBUN
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Gender:M
Credentials:CRNA
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Mailing Address - Street 1:11781 LEE JACKSON MEMORIAL HWY
Mailing Address - Street 2:STE 550
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-3309
Mailing Address - Country:US
Mailing Address - Phone:571-777-5164
Mailing Address - Fax:703-766-9725
Practice Address - Street 1:12 SYCAMORE LN
Practice Address - Street 2:
Practice Address - City:LONG VALLEY
Practice Address - State:NJ
Practice Address - Zip Code:07853-3327
Practice Address - Country:US
Practice Address - Phone:908-684-3435
Practice Address - Fax:973-973-2357
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2015-09-02
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Provider Licenses
StateLicense IDTaxonomies
NJ26NO10985500367500000X
NY677179367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400127151Medicare PIN
NYG400238002Medicare PIN
NJ058165YMOMedicare PIN