Basic Information
| Provider Information | |||||||||
| NPI: | 1467451021 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | PHELAN | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | T | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2 CATHARINE STREET | ||||||||
| Address2: | TROY ANESTHESIOLOGISTS PC | ||||||||
| City: | POUGHKEEPSIE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 12602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8457902661 | ||||||||
| FaxNumber: | 8457902675 | ||||||||
| Practice Location | |||||||||
| Address1: | 2215 BURDETT AVENUE | ||||||||
| Address2: | SAMARITAN HOSPITAL | ||||||||
| City: | TROY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 12180 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5182713258 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2005 | ||||||||
| LastUpdateDate: | 04/10/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 289107 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.