Healthcare Provider Details

I. General information

NPI: 1568441665
Provider Name (Legal Business Name): DANIEL L SKUBICK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 DEKALB PIKE
NORTH WALES PA
19454-1853
US

IV. Provider business mailing address

124 DEKALB PIKE
NORTH WALES PA
19454-1853
US

V. Phone/Fax

Practice location:
  • Phone: 215-699-3727
  • Fax:
Mailing address:
  • Phone: 215-699-3727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD017628E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: