1699774638 NPI number — DARRELL J. DATKO DO

Table of content: (NPI 1699774638)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699774638 NPI number — DARRELL J. DATKO DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DARRELL J. DATKO DO
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DJD ANESTHESIA ASSOCIATES
Provider Other Organization Name Type Code:
3
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:
1699774638
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/08/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 947
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHAMBERSBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17201-0947
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-263-5562
Provider Business Mailing Address Fax Number:
717-263-1566

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 HOSPITAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLARION
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16214-8501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-226-9500
Provider Business Practice Location Address Fax Number:
914-226-1228
Provider Enumeration Date:
07/20/2005

Additional Information

Authorized Official

Authorized Official Last Name:
DATKO
Authorized Official First Name:
DARREL
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
814-226-9500

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207LP2900X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 001818451 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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