Individual
DUSTIN DURHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
120 DINWIDDIE DR, NEW KENSINGTON, PA 15068-9392
(412) 807-8137
Mailing address
120 DINWIDDIE DR, NEW KENSINGTON, PA 15068-9392
(412) 807-8137
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
MA057071
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103205944
—
PA
Enumeration date
08/26/2014
Last updated
10/15/2020
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