Healthcare Provider Details

I. General information

NPI: 1083691968
Provider Name (Legal Business Name): DAVID JOHN DZURINKO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2005
Last Update Date: 03/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 N BROAD ST 7TH FLOOR OUT PATIENT BUILDING
PHILADELPHIA PA
19140-5103
US

IV. Provider business mailing address

2450 W HUNTING PARK AVE
PHILADELPHIA PA
19129-1302
US

V. Phone/Fax

Practice location:
  • Phone: 215-707-3008
  • Fax: 215-707-1387
Mailing address:
  • Phone: 215-707-8561
  • Fax: 215-707-3677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD 026315E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: