Provider Demographics
NPI:1548213580
Name:STATE COLLEGE ANESTHESIA ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:STATE COLLEGE ANESTHESIA ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:DURKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-235-3898
Mailing Address - Street 1:1530 MARTIN ST
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16803-3058
Mailing Address - Country:US
Mailing Address - Phone:814-235-3898
Mailing Address - Fax:814-235-3899
Practice Address - Street 1:1850 E PARK AVE
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16803-6706
Practice Address - Country:US
Practice Address - Phone:814-231-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010947360007Medicaid
PA1119OtherGEISINGER HEALTH PLAN
PA02719900OtherCAPITAL BLUE CROSS
PACN9411OtherRAILROAD MEDICARE
PA0010947360007Medicaid