Provider Demographics
NPI:1114085008
Name:DLUGOS, JODY E (PA-C)
Entity Type:Individual
Prefix:
First Name:JODY
Middle Name:E
Last Name:DLUGOS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 OLD ROUTE 119
Mailing Address - Street 2:
Mailing Address - City:HUNKER
Mailing Address - State:PA
Mailing Address - Zip Code:15639
Mailing Address - Country:US
Mailing Address - Phone:724-696-5505
Mailing Address - Fax:724-696-5571
Practice Address - Street 1:1007 OLD ROUTE 119
Practice Address - Street 2:
Practice Address - City:HUNKER
Practice Address - State:PA
Practice Address - Zip Code:15639
Practice Address - Country:US
Practice Address - Phone:724-696-5505
Practice Address - Fax:724-696-5571
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA003349L363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA041506Medicare ID - Type Unspecified
PAP12549Medicare UPIN