Individual
DANA RICHARD IDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.-C.
Contact information
Practice address
1250 S CEDAR CREST BLVD, STE 110, ALLENTOWN, PA 18103-6224
(610) 435-1003
(610) 435-3184
Mailing address
PO BOX 1754, ALLENTOWN, PA 18105-1754
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
MA002895L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1958641
HIGHMARK BLUE SHIELD
—
01
—
405198
HEALTHAMERICA/HEALTHASSUR
—
01
—
50053198
CAPITAL BLUE CROSS
—
01
—
P00261573
RAILROAD MEDICARE
—
Enumeration date
11/10/2005
Last updated
10/31/2014
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