Provider Demographics
NPI:1235135294
Name:DERIVAN, ALBERT T (MD)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:T
Last Name:DERIVAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:23438 SHANNONDELL DR
Mailing Address - Street 2:
Mailing Address - City:AUDUBON
Mailing Address - State:PA
Mailing Address - Zip Code:19403-5675
Mailing Address - Country:US
Mailing Address - Phone:215-260-1721
Mailing Address - Fax:610-382-6813
Practice Address - Street 1:23438 SHANNONDELL DR
Practice Address - Street 2:
Practice Address - City:AUDUBON
Practice Address - State:PA
Practice Address - Zip Code:19403-5675
Practice Address - Country:US
Practice Address - Phone:215-260-1721
Practice Address - Fax:610-382-6813
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-23
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD034282E2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry