Healthcare Provider Details

I. General information

NPI: 1700223013
Provider Name (Legal Business Name): ANDREW RICHARD DARGAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2013
Last Update Date: 10/28/2024
Certification Date: 10/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 CHESTNUT ST
PHILADELPHIA PA
19107-3612
US

IV. Provider business mailing address

743 S 20TH ST FL 1
PHILADELPHIA PA
19146-1846
US

V. Phone/Fax

Practice location:
  • Phone: 215-955-8900
  • Fax: 215-923-3447
Mailing address:
  • Phone: 417-489-2012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD467869
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number25MA10473900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: