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NPI Code Detail

MEDICARE: DR. DAN MARIO UDREA M.D.

MEDICARE:  DR. DAN MARIO UDREA  M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0800XPsychiatry PhysicianMD440609PA
22084P0804XChild & Adolescent Psychiatry PhysicianMD440609PA

General Provider Information

NPI Number : 1104072800
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DAN MARIO UDREA M.D.
Provider Business Mailing Address
First Line : 6500 BROOKTREE RD
Second Line : SUITE 208
City : WEXFORD
State : PA
Zip : 15090-9272
Country : US
Telephone Number : 724-799-8558
Fax Number :
Provider Business Practice Location Address
First Line : 6500 BROOKTREE RD
Second Line : SUITE 208
City : WEXFORD
State : PA
Zip : 15090-9272
Country : US
Telephone Number : 412-695-3181
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/13/2008
Last Update Date : 08/29/2017

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