Provider Demographics
NPI:1497754246
Name:TURTZO, DOUGLAS FRANKLIN (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:FRANKLIN
Last Name:TURTZO
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 1:101 S SCHANCK AVE
Mailing Address - Street 2:
Mailing Address - City:PEN ARGYL
Mailing Address - State:PA
Mailing Address - Zip Code:18072-1697
Mailing Address - Country:US
Mailing Address - Phone:610-863-9059
Mailing Address - Fax:610-863-1995
Practice Address - Street 1:101 S SCHANCK AVE
Practice Address - Street 2:
Practice Address - City:PEN ARGYL
Practice Address - State:PA
Practice Address - Zip Code:18072-1697
Practice Address - Country:US
Practice Address - Phone:610-863-9059
Practice Address - Fax:610-863-1995
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-14
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD01104E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0646414Medicaid
01037702OtherCAPITOL
137063OtherHIGHMARK
B36214Medicare UPIN
PA095410Medicare ID - Type Unspecified