Healthcare Provider Details

I. General information

NPI: 1013979657
Provider Name (Legal Business Name): DANIEL ALAN CHURCH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 01/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

246 ELM DR
WAYNESBURG PA
15370-8269
US

IV. Provider business mailing address

7 GLASSWORKS RD
GREENSBORO PA
15338-9507
US

V. Phone/Fax

Practice location:
  • Phone: 724-627-0926
  • Fax: 724-627-0812
Mailing address:
  • Phone: 724-943-3308
  • Fax: 724-943-4929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD072957L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: