Provider Demographics
NPI:1659366847
Name:DE FALCIS, DANIEL CARMINE (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:CARMINE
Last Name:DE FALCIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4811 JONESTOWN RD
Mailing Address - Street 2:SUITE 123
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17109-1745
Mailing Address - Country:US
Mailing Address - Phone:717-651-5800
Mailing Address - Fax:717-651-5808
Practice Address - Street 1:4811 JONESTOWN RD
Practice Address - Street 2:SUITE 123
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17109-1745
Practice Address - Country:US
Practice Address - Phone:717-651-5800
Practice Address - Fax:717-651-5808
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD065894L208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
400034000OtherMARYLAND MEDICAID
PA0016928000006Medicaid
01020802OtherCAPITAL BLUE CROSS
CE1386745OtherBLUE SHIELD ASSGN ACCT
G37593OtherSOUTH CENTRAL PREFERRED
PA1699280Medicaid
2697173OtherAETNA
130772OtherMEDPLUS 3 RIVERS
2103000OtherMAMSI
2103000OtherALLIANCE PPO
974483OtherBLUE SHIELD
PAP00431001OtherRAIL ROAD MEDICARE
1527661OtherGATEWAY
G37593OtherHEALTHASSURANCE
G37593OtherHEALTHAMERICA
PA0016992800003Medicaid
41790OtherGEISINGER HEALTH PLAN
N86745OtherAMERIHEALTH ADMINISTRATOR
20019902OtherAMERIHEALTH MERCY NON PAR
PA011209Medicare PIN