Provider Demographics
NPI:1023036282
Name:D'ANNUNZIO, DONALD RAYMOND (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:RAYMOND
Last Name:D'ANNUNZIO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 ERFORD RD
Mailing Address - Street 2:
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-1807
Mailing Address - Country:US
Mailing Address - Phone:717-763-7685
Mailing Address - Fax:717-975-2950
Practice Address - Street 1:104 ERFORD RD
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-1807
Practice Address - Country:US
Practice Address - Phone:717-763-7685
Practice Address - Fax:717-975-2950
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD065115L207ND0101X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Not Answered207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01734201OtherCAPITAL BLUE CROSS
PA267274OtherBLUE SHIELD
PA01734201OtherCAPITAL BLUE CROSS
PA007964EMYMedicare ID - Type UnspecifiedMEDICARE