Provider Demographics
NPI:1003810045
Name:DIVERIO, DONALD DURAND JR (DO)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:DURAND
Last Name:DIVERIO
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 GOOD DR
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-4349
Mailing Address - Country:US
Mailing Address - Phone:717-299-3077
Mailing Address - Fax:717-299-3241
Practice Address - Street 1:101 GOOD DR
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-4349
Practice Address - Country:US
Practice Address - Phone:717-299-3077
Practice Address - Fax:717-299-3241
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS-007347-E207X00000X
NJMB55629207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001240665Medicaid
PAE86192Medicare UPIN
PA001240665Medicaid