1376832683 NPI number — MR. ANTHONY M YANARELLA CRNA

Table of content: MR. ANTHONY M YANARELLA CRNA (NPI 1376832683)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376832683 NPI number — MR. ANTHONY M YANARELLA CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YANARELLA
Provider First Name:
ANTHONY
Provider Middle Name:
M
Provider Name Prefix Text:
MR.
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:
1376832683
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/18/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 650782
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75265-0782
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-733-0806
Provider Business Mailing Address Fax Number:
302-733-0854

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
175 E CHESTER PIKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RIDLEY PARK
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19078-2212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-442-5085
Provider Business Practice Location Address Fax Number:
877-329-2370
Provider Enumeration Date:
04/07/2011

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:  RN563713 , 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)

  • Identifier: 102623251 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: L1-0034310 . This is a "RN LICENSE" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 050514 . This is a "MEDICARE GROUP #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 087419 . This is a "AANA NUMBER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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