Basic Information
| Provider Information | |||||||||
| NPI: | 1508156258 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DISTEL | ||||||||
| FirstName: | DONALD | ||||||||
| MiddleName: | FRANK | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1800 LOMBARD STREET | ||||||||
| Address2: | GROUND FLOOR | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191461498 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2158932600 | ||||||||
| FaxNumber: | 2158932610 | ||||||||
| Practice Location | |||||||||
| Address1: | 1800 LOMBARD STREET | ||||||||
| Address2: | GROUND FLOOR | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191461498 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2158932600 | ||||||||
| FaxNumber: | 2158932610 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/14/2011 | ||||||||
| LastUpdateDate: | 09/06/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2081P0004X | MD474744 | PA | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Spinal Cord Injury Medicine | 208100000X | MD474744 | PA | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
No ID Information.