Provider Demographics
NPI:1619936408
Name:ESAA, DURRIYA S (MD)
Entity Type:Individual
Prefix:
First Name:DURRIYA
Middle Name:S
Last Name:ESAA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 HARDEES DR
Mailing Address - Street 2:
Mailing Address - City:MIFFLINBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17844-7062
Mailing Address - Country:US
Mailing Address - Phone:866-995-3937
Mailing Address - Fax:570-966-5586
Practice Address - Street 1:4 EYE CENTER DR
Practice Address - Street 2:
Practice Address - City:MUNCY
Practice Address - State:PA
Practice Address - Zip Code:17756-9200
Practice Address - Country:US
Practice Address - Phone:866-995-3937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD043700L207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA670649OtherBLUE SHIELD
PA670649OtherBLUE SHIELD
PA670649Medicare ID - Type Unspecified
PA1007503440003Medicaid
PA1619936408Medicare NSC
PA090617Medicare PIN