MEDICARE: DR. JOHN CHARLES DARRELL M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	35099045	OH
2	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	MD043753E	PA

General Provider Information

NPI Number	:	1801893573
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN CHARLES DARRELL M.D.

Provider Business Mailing Address
First Line	:	100 N ACADEMY AVE
Second Line	:
City	:	DANVILLE
State	:	PA
Zip	:	17822-4903
Country	:	US
Telephone Number	:	570-271-6144
Fax Number	:	570-271-6578

Provider Business Practice Location Address
First Line	:	1000 E MOUNTAIN BLVD
Second Line	:
City	:	WILKES BARRE
State	:	PA
Zip	:	18711-0027
Country	:	US
Telephone Number	:	570-808-6020
Fax Number	:	570-808-2306

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	06/19/2020

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