Provider Demographics
NPI:1558344283
Name:MAKISHI, DARYL Y (DO)
Entity Type:Individual
Prefix:
First Name:DARYL
Middle Name:Y
Last Name:MAKISHI
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 1:160 GALLERY DR STE 800
Mailing Address - Street 2:
Mailing Address - City:CANONSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15317-2690
Mailing Address - Country:US
Mailing Address - Phone:724-260-7250
Mailing Address - Fax:724-260-7272
Practice Address - Street 1:160 GALLERY DR STE 800
Practice Address - Street 2:
Practice Address - City:CANONSBURG
Practice Address - State:PA
Practice Address - Zip Code:15317-2690
Practice Address - Country:US
Practice Address - Phone:724-260-7250
Practice Address - Fax:724-260-7272
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2020-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS0121462085R0203X, 2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102647950Medicaid
PA102647950Medicaid
PA102647950Medicaid