Provider Demographics
NPI:1003291063
Name:MIDDLETOWN FUNCTIONAL CENTER PC
Entity type:Organization
Organization Name:MIDDLETOWN FUNCTIONAL CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:DARLING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-554-0355
Mailing Address - Street 1:3781 WESTERRE PKWY
Mailing Address - Street 2:SUITE C
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23233-1328
Mailing Address - Country:US
Mailing Address - Phone:804-554-0355
Mailing Address - Fax:
Practice Address - Street 1:586 FULLING MILL RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:PA
Practice Address - Zip Code:17057-2966
Practice Address - Country:US
Practice Address - Phone:717-616-3318
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-20
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010603620005Medicaid
PAC34562Medicare UPIN