Provider Demographics
NPI:1164491551
Name:DURAKO, ROBERT A (DO)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:A
Last Name:DURAKO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 MAHONING ST
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18018-6332
Mailing Address - Country:US
Mailing Address - Phone:610-379-0200
Mailing Address - Fax:610-379-0216
Practice Address - Street 1:1001 MAHONING ST
Practice Address - Street 2:
Practice Address - City:LEHIGHTON
Practice Address - State:PA
Practice Address - Zip Code:18235-1123
Practice Address - Country:US
Practice Address - Phone:610-379-0200
Practice Address - Fax:610-379-0216
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS008081L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0014050030006Medicaid
PAF52859Medicare UPIN
PA736687Medicare ID - Type UnspecifiedMEDICARE