Provider Demographics
NPI:1841282233
Name:DY, VICTOR C (MD)
Entity type:Individual
Prefix:
First Name:VICTOR
Middle Name:C
Last Name:DY
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 1:3417 BRIDLEPATH RD
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18045-2009
Mailing Address - Country:US
Mailing Address - Phone:610-442-2791
Mailing Address - Fax:
Practice Address - Street 1:3417 BRIDLEPATH RD
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18045-2009
Practice Address - Country:US
Practice Address - Phone:610-442-2791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD035392-L208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1019207990001Medicaid
PA141482OtherBLUE SHIELD
PA2301000OtherBLUE CROSS
PA2301000OtherBLUE CROSS
PA141482Medicare ID - Type Unspecified