1972959153 NPI number — D & P MEDICAL GROUP LLC

Table of content: (NPI 1972959153)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972959153 NPI number — D & P MEDICAL GROUP LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
D & P MEDICAL GROUP LLC
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:
1972959153
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/24/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 791
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARNEGIE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15106-0791
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-655-4362
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
316 1ST AVE STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KITTANNING
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16201-2267
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-655-4362
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/06/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DONER
Authorized Official First Name:
BRYAN
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
412-496-6365

Provider Taxonomy Codes

  • Taxonomy code: 207PE0005X , with the licence number:  OS015400 , 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: 1031380280007 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: OS015499 . This is a "STATE LICENSE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".