Provider Demographics
NPI:1326039413
Name:DAMIANO, MICHAEL D (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:D
Last Name:DAMIANO
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 1:995 OLD EAGLE SCHOOL RD
Mailing Address - Street 2:SUITE 304-F
Mailing Address - City:WAYNE
Mailing Address - State:PA
Mailing Address - Zip Code:19087-1709
Mailing Address - Country:US
Mailing Address - Phone:610-688-3099
Mailing Address - Fax:610-687-5350
Practice Address - Street 1:995 OLD EAGLE SCHOOL RD
Practice Address - Street 2:SUITE 304-F
Practice Address - City:WAYNE
Practice Address - State:PA
Practice Address - Zip Code:19087-1709
Practice Address - Country:US
Practice Address - Phone:610-688-3099
Practice Address - Fax:610-687-5350
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD045134E174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAE65395Medicare UPIN