Provider Demographics
NPI:1124094495
Name:ROOSA, CARL D II (CRNA)
Entity type:Individual
Prefix:
First Name:CARL
Middle Name:D
Last Name:ROOSA
Suffix:II
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 1:2 READS WAY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NEW CASTLE
Mailing Address - State:DE
Mailing Address - Zip Code:19720
Mailing Address - Country:US
Mailing Address - Phone:302-709-4709
Mailing Address - Fax:302-709-4551
Practice Address - Street 1:2 READS WAY
Practice Address - Street 2:SUITE 201
Practice Address - City:NEW CASTLE
Practice Address - State:DE
Practice Address - Zip Code:19720
Practice Address - Country:US
Practice Address - Phone:302-709-4709
Practice Address - Fax:302-709-4551
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL60A00129367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
001156K95Medicare ID - Type Unspecified