Provider Demographics
NPI:1649235052
Name:TURCO, PHILLIP J (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:J
Last Name:TURCO
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 1:436 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15902-2511
Mailing Address - Country:US
Mailing Address - Phone:814-536-2063
Mailing Address - Fax:814-536-7753
Practice Address - Street 1:436 PARK AVE
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15902-2511
Practice Address - Country:US
Practice Address - Phone:814-536-2063
Practice Address - Fax:814-536-7753
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD039755L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010152500001Medicaid
PA192813Medicare ID - Type Unspecified