Healthcare Provider Details

I. General information

NPI: 1366417818
Provider Name (Legal Business Name): DANIEL A PRYMA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2006
Last Update Date: 05/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 SPRUCE ST.
PHILADELPHIA PA
19104-4206
US

IV. Provider business mailing address

3400 SPRUCE ST. 1 SILVERSTEIN
PHILADELPHIA PA
19104-4206
US

V. Phone/Fax

Practice location:
  • Phone: 215-579-1300
  • Fax:
Mailing address:
  • Phone: 215-662-3005
  • Fax: 215-662-7011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD427361
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License NumberMD427361
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: