Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | OS017458 | PA |
N | 207QS0010X | Family Doctor - Sports Medicine | OS017458 | PA |
NPI | 1003171141 |
---|---|
Provider Name | Donald David Dangle |
First Address | Middleburg, PA 17842-8910 |
Second Address | Loysville, PA 17047-9200 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/07/2012 |
Last Update Date | 07/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1030407550001 | (05) | PA |