Organization
PLASTIC SURGICAL ASSOCIATES OF JOHNSTOWN INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DANIEL R NEVARRE MD (DIRECTOR/CEO)
(814) 536-9000
Entity
Organization
Contact information
Practice address
415 NAPOLEON PL, JOHNSTOWN, PA 15901-2504
(814) 536-9000
(814) 536-8999
Mailing address
415 NAPOLEON PL, JOHNSTOWN, PA 15901-2504
(814) 536-9000
(814) 536-8999
Taxonomy
Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
—
—
291U00000X
Clinical Medical Laboratory
032123
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0006508380002
—
PA
01
—
012931
HIGHMARK GROUP NUMBER
PA
01
—
032123
LABORATORY STATE LICENSE NUMBER
PA
01
—
39D2029791
CLIA
PA
Enumeration date
12/18/2006
Last updated
02/22/2012
Update your record
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