1841247905 NPI number — ALEXANDER THEODORE SKIADAS CRNA

Table of content: ALEXANDER THEODORE SKIADAS CRNA (NPI 1841247905)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841247905 NPI number — ALEXANDER THEODORE SKIADAS CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SKIADAS
Provider First Name:
ALEXANDER
Provider Middle Name:
THEODORE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1841247905
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/28/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
30 MEDICAL CENTER BLVD
Provider Second Line Business Mailing Address:
SUITE 305, ASSOCIATES IN ANESTHESI
Provider Business Mailing Address City Name:
UPLAND
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19013
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-874-6448
Provider Business Mailing Address Fax Number:
215-615-0500

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30 MEDICAL CENTER BLVD
Provider Second Line Business Practice Location Address:
SUITE 305, ASSOCIATES IN ANESTHESI
Provider Business Practice Location Address City Name:
CHESTER
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19013-3955
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-874-6448
Provider Business Practice Location Address Fax Number:
215-615-0500
Provider Enumeration Date:
05/27/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  RN571423 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)