Healthcare Provider Details

I. General information

NPI: 1487705430
Provider Name (Legal Business Name): JEFFREY T DARNALL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 08/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BARTOL AVE SUITE 103
RIDLEY PARK PA
19078-2214
US

IV. Provider business mailing address

1 BARTOL AVE SUITE 103
RIDLEY PARK PA
19078-2214
US

V. Phone/Fax

Practice location:
  • Phone: 610-521-3022
  • Fax: 610-521-5715
Mailing address:
  • Phone: 610-521-3202
  • Fax: 610-497-7937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD019879E
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberMD019879E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: