Healthcare Provider Details

I. General information

NPI: 1689858482
Provider Name (Legal Business Name): DORENE M MORRIS, D.O.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2007
Last Update Date: 12/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 ERIE ST EXT
SAEGERTOWN PA
16433
US

IV. Provider business mailing address

700 ERIE ST EXT
SAEGERTOWN PA
16433
US

V. Phone/Fax

Practice location:
  • Phone: 814-763-2010
  • Fax: 814-763-5535
Mailing address:
  • Phone: 814-763-2010
  • Fax: 814-763-5535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS007956L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberOS007956L
License Number StatePA

VIII. Authorized Official

Name: DORENE M MORRIS
Title or Position: D.O./OWNER
Credential:
Phone: 814-763-2010