Healthcare Provider Details
I. General information
NPI: 1154412138
Provider Name (Legal Business Name): DANIEL JOSEPH KAZMIERSKI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 09/27/2006
Last Update Date: 11/23/2021
Certification Date: 11/23/2021
Deactivation Date:
Reactivation Date:
III. Provider practice location address
1789 N KEYSER AVE
SCRANTON PA
18508-1250
US
IV. Provider business mailing address
1789 N KEYSER AVE
SCRANTON PA
18508-1250
US
V. Phone/Fax
- Phone: 570-969-1904
- Fax: 570-207-5314
- Phone: 570-969-1904
- Fax: 570-969-2916
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207Q00000X |
| Taxonomy | Family Medicine Physician |
| License Number | MD048304L |
| License Number State | PA |
VII. Legacy identifiers
For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:
| # 1 | |
| Identifier | 11230 E476 |
| Identifier Type | OTHER |
| Identifier State | PA |
| Identifier Issuer | GEISINGER HEALTH PLAN |
| # 2 | |
| Identifier | 001245 |
| Identifier Type | OTHER |
| Identifier State | PA |
| Identifier Issuer | FIRST PRIORITY HEALTHNEPA |
| # 3 | |
| Identifier | 080041674 |
| Identifier Type | OTHER |
| Identifier State | PA |
| Identifier Issuer | RAILROAD MEDICARE |
| # 4 | |
| Identifier | 734400 |
| Identifier Type | OTHER |
| Identifier State | PA |
| Identifier Issuer | FIRST PRIORITY LIFE |
| # 5 | |
| Identifier | 0014126800001 |
| Identifier Type | MEDICAID |
| Identifier State | PA |
| Identifier Issuer | |
| # 6 | |
| Identifier | 010175800 |
| Identifier Type | OTHER |
| Identifier State | PA |
| Identifier Issuer | BLACK LUNG |
| # 7 | |
| Identifier | 0536755 |
| Identifier Type | OTHER |
| Identifier State | PA |
| Identifier Issuer | AETNA |
| # 8 | |
| Identifier | 242159 |
| Identifier Type | OTHER |
| Identifier State | PA |
| Identifier Issuer | HEALTH AMERICA |
| # 9 | |
| Identifier | 0536755 |
| Identifier Type | OTHER |
| Identifier State | PA |
| Identifier Issuer | UNITED HEALTHCARE |
| # 10 | |
| Identifier | 0638250000 |
| Identifier Type | OTHER |
| Identifier State | PA |
| Identifier Issuer | PABS PERSONAL CHOICE |
| # 11 | |
| Identifier | 11230 E476 |
| Identifier Type | OTHER |
| Identifier State | PA |
| Identifier Issuer | GEISINGER GOLD |
| # 12 | |
| Identifier | 734400 |
| Identifier Type | OTHER |
| Identifier State | PA |
| Identifier Issuer | PA BLUESHIELD |
| # 13 | |
| Identifier | F52043 |
| Identifier Type | OTHER |
| Identifier State | PA |
| Identifier Issuer | STERLING |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone:
