Provider Demographics
NPI:1417958083
Name:DREYFUS, DARREN E (DO)
Entity Type:Individual
Prefix:DR
First Name:DARREN
Middle Name:E
Last Name:DREYFUS
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 1:311 W 24TH ST
Mailing Address - Street 2:SUITE 402
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16502-2665
Mailing Address - Country:US
Mailing Address - Phone:814-453-6687
Mailing Address - Fax:814-456-4676
Practice Address - Street 1:311 W 24TH ST
Practice Address - Street 2:SUITE 402
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16502-2665
Practice Address - Country:US
Practice Address - Phone:814-453-6687
Practice Address - Fax:814-456-4676
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2009-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS012098207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA390008355OtherMEDICARE PALMETTO
PA1394444OtherHIGHMARK PA BS
PA314113OtherUPMC
PA0019246140002Medicaid
PA059275Medicare ID - Type Unspecified
PA0019246140002Medicaid