Healthcare Provider Details

I. General information

NPI: 1699774638
Provider Name (Legal Business Name): DARRELL J. DATKO DO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 07/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOSPITAL DR
CLARION PA
16214-8501
US

IV. Provider business mailing address

PO BOX 947
CHAMBERSBURG PA
17201-0947
US

V. Phone/Fax

Practice location:
  • Phone: 814-226-9500
  • Fax: 914-226-1228
Mailing address:
  • Phone: 717-263-5562
  • Fax: 717-263-1566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier001818451
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: DARREL J. DATKO
Title or Position: PRESIDENT
Credential: DO
Phone: 814-226-9500