Healthcare Provider Details

I. General information

NPI: 1588128144
Provider Name (Legal Business Name): DANE HILKO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2019
Last Update Date: 10/26/2021
Certification Date: 10/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MEDICAL BLVD
CANONSBURG PA
15317-9762
US

IV. Provider business mailing address

100 MEDICAL BLVD
CANONSBURG PA
15317-9762
US

V. Phone/Fax

Practice location:
  • Phone: 412-359-3030
  • Fax: 412-359-3060
Mailing address:
  • Phone: 412-359-3030
  • Fax: 412-359-3060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA060361
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: