Provider Demographics
NPI:1942206164
Name:TYRRELL, DANA R (MD)
Entity Type:Individual
Prefix:DR
First Name:DANA
Middle Name:R
Last Name:TYRRELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:DANA
Other - Middle Name:R
Other - Last Name:TYRRELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:100 EXCELA HEALTH DR STE 202
Mailing Address - Street 2:
Mailing Address - City:LATROBE
Mailing Address - State:PA
Mailing Address - Zip Code:15650-9001
Mailing Address - Country:US
Mailing Address - Phone:724-537-7100
Mailing Address - Fax:270-538-9554
Practice Address - Street 1:100 EXCELA HEALTH DR STE 202
Practice Address - Street 2:
Practice Address - City:LATROBE
Practice Address - State:PA
Practice Address - Zip Code:15650-9001
Practice Address - Country:US
Practice Address - Phone:724-537-7100
Practice Address - Fax:724-537-9847
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD067294L208600000X
KY36274208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64023179Medicaid
KY00072002Medicare PIN
KYG63360Medicare UPIN