Individual
JEROME D. DERDEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1800 E PARK AVE, STATE COLLEGE, PA 16803-6709
(814) 234-6726
(814) 234-1553
Mailing address
100 N ACADEMY AVE, DANVILLE, PA 17822-4903
(570) 271-6144
(570) 271-6578
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
MD038685L
PA
2085R0203X
Therapeutic Radiology Physician
Primary
MD038685L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1104812601
NPI
—
Enumeration date
09/21/2005
Last updated
06/21/2023
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