Provider Demographics
NPI:1982600557
Name:DASHAWETZ, ROMAN W (CRNA)
Entity Type:Individual
Prefix:
First Name:ROMAN
Middle Name:W
Last Name:DASHAWETZ
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 1:907 SUMNER ST M201
Mailing Address - Street 2:GUARDIAN ANESTHESIA INC
Mailing Address - City:STOUGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02072
Mailing Address - Country:US
Mailing Address - Phone:781-344-2325
Mailing Address - Fax:781-341-8544
Practice Address - Street 1:907 SUMNER ST
Practice Address - Street 2:GUARDIAN ANESTHESIA INC
Practice Address - City:STOUGHTON
Practice Address - State:MA
Practice Address - Zip Code:02072
Practice Address - Country:US
Practice Address - Phone:781-344-2325
Practice Address - Fax:781-341-8544
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ME46667367500000X
MA146986367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMM9115Medicare ID - Type Unspecified