Basic Information
| Provider Information | |||||||||
| NPI: | 1912131848 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | DPA MEDICAL SERVICES INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 621 WEST MAIN STREET | ||||||||
| Address2: | |||||||||
| City: | LIGONIER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 156581017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7242384103 | ||||||||
| FaxNumber: | 7242384107 | ||||||||
| Practice Location | |||||||||
| Address1: | 621 WEST MAIN STREET | ||||||||
| Address2: | |||||||||
| City: | LIGONIER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 156581017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7242384103 | ||||||||
| FaxNumber: | 7242384107 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/06/2009 | ||||||||
| LastUpdateDate: | 05/10/2011 | ||||||||
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| AuthorizedOfficialLastName: | ANTO | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | P | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7242383560 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2300X | MD050755L | PA | Y | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |
ID Information
| ID | Type | State | Issuer | Description | 154629 | 01 | PA | PTAN | OTHER |