=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558344283
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DARYL Y MAKISHI D.O.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/28/2005
-----------------------------------------------------
Last Update Date | 10/10/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 160 GALLERY DR STE 800
-----------------------------------------------------
City | CANONSBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15317-2690
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-260-7250
-----------------------------------------------------
Fax | 724-260-7272
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 160 GALLERY DR STE 800
-----------------------------------------------------
City | CANONSBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15317-2690
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-260-7250
-----------------------------------------------------
Fax | 724-260-7272
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0203X
-----------------------------------------------------
Taxonomy Name | Therapeutic Radiology Physician
-----------------------------------------------------
License Number | OS012146
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2085R0001X
-----------------------------------------------------
Taxonomy Name | Radiation Oncology Physician
-----------------------------------------------------
License Number | OS012146
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------