Healthcare Provider Details

I. General information

NPI: 1750743902
Provider Name (Legal Business Name): DAMIAN DRAGUN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2016
Last Update Date: 03/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

157 WYNNE ST
PITTSBURGH PA
15209-1626
US

IV. Provider business mailing address

157 WYNNE ST
PITTSBURGH PA
15209-1626
US

V. Phone/Fax

Practice location:
  • Phone: 412-638-9043
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN636414
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: