Provider Demographics
NPI:1912908047
Name:PLATT, DWAYNE L JR (MD)
Entity Type:Individual
Prefix:
First Name:DWAYNE
Middle Name:L
Last Name:PLATT
Suffix:JR
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 1:231 ORD STREET
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:PA
Mailing Address - Zip Code:15558-0066
Mailing Address - Country:US
Mailing Address - Phone:814-662-2755
Mailing Address - Fax:814-662-2001
Practice Address - Street 1:231 ORD STREET
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:PA
Practice Address - Zip Code:15558-0066
Practice Address - Country:US
Practice Address - Phone:814-662-2755
Practice Address - Fax:814-662-2001
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD072282L207Q00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018295800013Medicaid
PA0018295800004Medicaid
PA0018295800004Medicaid
PA045102Medicare PIN