Healthcare Provider Details

I. General information

NPI: 1033102017
Provider Name (Legal Business Name): VSEVOLOD DOUNAEVSKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2005
Last Update Date: 08/12/2020
Certification Date: 08/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 HIGHLAND AVE LEWISTOWN HOSPITAL
LEWISTOWN PA
17044-1167
US

IV. Provider business mailing address

400 HIGHLAND AVE
LEWISTOWN PA
17044-1167
US

V. Phone/Fax

Practice location:
  • Phone: 717-248-5411
  • Fax:
Mailing address:
  • Phone: 717-242-7473
  • Fax: 717-242-7478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD070506L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: