Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | MD015059E | PA |
Y | 111NI0900X | Internist | MD015059E | PA |
N | 207RA0401X | Internist - Addiction Medicine | MD015059E | PA |
NPI | 1699796458 |
---|---|
Provider Name | Christopher Damanda |
First Address | Philadelphia, PA 19122-4212 |
Second Address | Philadelphia, PA 19130 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2006 |
Last Update Date | 26/09/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000964295 | (05) | PA |
0096429502 | AMERICHOICE (01) | PA |
1125305 | KEYSTONE MERCY (01) | PA |
117015 | CBH (01) | PA |
13361 | HEALTH PARTNERS (01) | PA |
7990000015 | RR MEDICARE (01) | PA |
D71243 | (02) |