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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
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