Provider Demographics
NPI:1245420330
Name:TSYVINE, DANIEL (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:
Last Name:TSYVINE
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 1:3 LIFE MARK DR STE 1
Mailing Address - Street 2:
Mailing Address - City:SELLERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18960-1598
Mailing Address - Country:US
Mailing Address - Phone:215-257-1127
Mailing Address - Fax:215-257-1127
Practice Address - Street 1:610 WYOMING AVE STE 2
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-3702
Practice Address - Country:US
Practice Address - Phone:570-552-7130
Practice Address - Fax:570-552-7135
Is Sole Proprietor?:No
Enumeration Date:2007-07-26
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD445820207RC0000X, 207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMD445820OtherMEDICAL LICENSE
NJ25MA08405300OtherMEDICAL LICENSE