Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | MD019256E | PA |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | MD19256E | PA |
NPI | 1205868866 |
---|---|
Provider Name | Dennis M Devita |
First Address | Danville, PA 17822-4903 |
Second Address | Lewistown, PA 17044-1369 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2006 |
Last Update Date | 24/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0007712160001 | (05) | PA |
01026901 | CAPITAL BLUE CROSS (01) | PA |
147667 | HIGHMARK BLUE SHIELD (01) | PA |
200002950 | PALMETTO GBA (01) | PA |
B39780 | (02) | PA |