Provider Demographics
NPI:1215535554
Name:DVORACSAK, ANTON
Entity Type:Individual
Prefix:
First Name:ANTON
Middle Name:
Last Name:DVORACSAK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 CHOW CHOW LN
Mailing Address - Street 2:
Mailing Address - City:HARPERS FERRY
Mailing Address - State:WV
Mailing Address - Zip Code:25425-1447
Mailing Address - Country:US
Mailing Address - Phone:304-788-7670
Mailing Address - Fax:
Practice Address - Street 1:55 CHOW CHOW LN
Practice Address - Street 2:
Practice Address - City:HARPERS FERRY
Practice Address - State:WV
Practice Address - Zip Code:25425-1447
Practice Address - Country:US
Practice Address - Phone:304-788-7670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-09
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant