Provider Demographics
NPI:1073507943
Name:LOCKE, DARRON B (MD)
Entity Type:Individual
Prefix:
First Name:DARRON
Middle Name:B
Last Name:LOCKE
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 1:111 NASON DR
Mailing Address - Street 2:STE 101
Mailing Address - City:ROARING SPRING
Mailing Address - State:PA
Mailing Address - Zip Code:16673-1212
Mailing Address - Country:US
Mailing Address - Phone:814-224-5132
Mailing Address - Fax:814-224-2903
Practice Address - Street 1:111 NASON DR
Practice Address - Street 2:STE 101
Practice Address - City:ROARING SPRING
Practice Address - State:PA
Practice Address - Zip Code:16673-1212
Practice Address - Country:US
Practice Address - Phone:814-224-5132
Practice Address - Fax:814-224-2903
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD048590L208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0014132010001Medicaid
PA0015716860011OtherDPA GROUP #
PA023390100OtherUMW (BLACK LUNG)
PA838788OtherHIGHMARK GROUP #
PA080045281OtherRR TRAVELERS
PA838788OtherMEDICARE GROUP #
PA838788OtherMEDICARE GROUP #
PA023390100OtherUMW (BLACK LUNG)