Provider Demographics
NPI:1013177179
Name:DANILO L GUANZON M D INC
Entity Type:Organization
Organization Name:DANILO L GUANZON M D INC
Other - Org Name:DANILO L GUANZON
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANILO
Authorized Official - Middle Name:L
Authorized Official - Last Name:GUANZON
Authorized Official - Suffix:
Authorized Official - Credentials:M D INC
Authorized Official - Phone:814-724-5900
Mailing Address - Street 1:764 KENNEDY ST
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-2209
Mailing Address - Country:US
Mailing Address - Phone:814-724-5900
Mailing Address - Fax:
Practice Address - Street 1:764 KENNEDY ST
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-2209
Practice Address - Country:US
Practice Address - Phone:814-724-5900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-12
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1013177179Medicare PIN