Provider Demographics
NPI:1083691968
Name:DZURINKO, DAVID JOHN (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:JOHN
Last Name:DZURINKO
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 1:2450 W HUNTING PARK AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19129-1302
Mailing Address - Country:US
Mailing Address - Phone:215-707-8561
Mailing Address - Fax:215-707-3677
Practice Address - Street 1:3401 N BROAD ST
Practice Address - Street 2:7TH FLOOR OUT PATIENT BUILDING
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19140-5103
Practice Address - Country:US
Practice Address - Phone:215-707-3008
Practice Address - Fax:215-707-1387
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD 026315E207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001196692Medicaid
PA160052548OtherRR MEDICARE
PA0052792000OtherINDEPENDENCE BLUE CROSS
PA065674OtherHIGHMARK BLUE SHIELD
PA1578942OtherAETNA HMO
PA30040344OtherKKMHP
PA4414790OtherAETNA PPO
PA30038165OtherKMHP
PA3Y2472OtherHEALTH NET
PA597586OtherMEDICARE GROUP
PA2910OtherBRAVO HEALTH
PA065674Medicare PIN
PA30038165OtherKMHP