1982800330 NPI number — EUGENE T DANKO MD LTD

Table of content: BRENDA JOELLE DEW RPH (NPI 1790387330)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982800330 NPI number — EUGENE T DANKO MD LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EUGENE T DANKO MD LTD
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:
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:
1982800330
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
503 VALHALLA DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEWICKLEY
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15143-9335
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-741-3390
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
890 BEAVER GRADE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOON TOWNSHIP
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15108-2653
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-269-9995
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DANKO
Authorized Official First Name:
EUGENE
Authorized Official Middle Name:
THOMAS
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
412-741-3390

Provider Taxonomy Codes

  • Taxonomy code: 2085R0204X , with the licence number:  MD029049L , 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: 0653025 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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