Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 79169 | MA |
NPI | 1003816695 |
---|---|
Provider Name | Dr. Andrew Walter Danyluk |
First Address | Lanesboro, MA 01237-1490 |
Second Address | Pittsfield, MA 01201-4172 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3132340 | (05) | MA |
A59857 | (02) |