Basic Information
| Provider Information | |||||||||
| NPI: | 1578626297 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NEGOIANU | ||||||||
| FirstName: | DAN | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3400 SPRUCE STREET | ||||||||
| Address2: | 210 WHITE BUILDING | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191044228 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2156622638 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3400 SPRUCE STREET | ||||||||
| Address2: | 210 WHITE BUILDING | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191044228 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2156622638 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/18/2006 | ||||||||
| LastUpdateDate: | 11/28/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | MT187146 | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | 207RN0300X | MD429778 | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | 1021761400001 | 05 | PA | MEDICAID | 0178772 | 05 | NJ | MEDICAID |