Provider Demographics
NPI:1427199637
Name:DAS, NIRODE C (MD)
Entity Type:Individual
Prefix:DR
First Name:NIRODE
Middle Name:C
Last Name:DAS
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 1:667 N RIVER ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PLAINS
Mailing Address - State:PA
Mailing Address - Zip Code:18705-1013
Mailing Address - Country:US
Mailing Address - Phone:570-823-1111
Mailing Address - Fax:570-824-9044
Practice Address - Street 1:667 N RIVER ST
Practice Address - Street 2:SUITE 201
Practice Address - City:PLAINS
Practice Address - State:PA
Practice Address - Zip Code:18705-1013
Practice Address - Country:US
Practice Address - Phone:570-823-1111
Practice Address - Fax:570-824-9044
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD035730L207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA069304-14Medicaid
PA814155OtherFIRST PRIORITY HEALTH INS
PA814155OtherFIRST PRIORITY HEALTH INS
PA069304-14Medicaid