Provider Demographics
NPI:1265736664
Name:BENDER, DANIEL T (PA-C, MPA-S)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:T
Last Name:BENDER
Suffix:
Gender:M
Credentials:PA-C, MPA-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 40
Mailing Address - Street 2:
Mailing Address - City:ORBISONIA
Mailing Address - State:PA
Mailing Address - Zip Code:17243
Mailing Address - Country:US
Mailing Address - Phone:814-447-5556
Mailing Address - Fax:814-447-5682
Practice Address - Street 1:626 WATER STREET
Practice Address - Street 2:
Practice Address - City:ORBISONIA
Practice Address - State:PA
Practice Address - Zip Code:17243
Practice Address - Country:US
Practice Address - Phone:814-447-5556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-29
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA002377363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0008434780002Medicaid
PA393824Medicare Oscar/Certification