Provider Demographics
NPI:1134333412
Name:VICTORIA, DANIEL F P (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:F P
Last Name:VICTORIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17331-2275
Mailing Address - Country:US
Mailing Address - Phone:717-637-7755
Mailing Address - Fax:570-271-6578
Practice Address - Street 1:20 NORTH ST
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-2275
Practice Address - Country:US
Practice Address - Phone:717-637-7755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT188429207V00000X
PAMD450257207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102882745Medicaid