Provider Demographics
NPI:1881601490
Name:MADONI, RICHARD (CRNA)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:
Last Name:MADONI
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:428 JACKSON DR
Mailing Address - Street 2:
Mailing Address - City:APOLLO
Mailing Address - State:PA
Mailing Address - Zip Code:15613-1715
Mailing Address - Country:US
Mailing Address - Phone:724-733-0060
Mailing Address - Fax:
Practice Address - Street 1:400 HOLLAND AVE
Practice Address - Street 2:
Practice Address - City:BRADDOCK
Practice Address - State:PA
Practice Address - Zip Code:15104-1599
Practice Address - Country:US
Practice Address - Phone:412-636-5167
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN189738L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARN189738LOtherRN LICENCE
29183OtherNATIONAL CRNA #
PA693096Medicare ID - Type Unspecified