Basic Information
Provider Information | |||||||||
NPI: | 1467740035 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | DANIEL | ||||||||
FirstName: | KRUPA | ||||||||
MiddleName: | GRACE | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | D.O | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | MATHEW | ||||||||
OtherFirstName: | KRUPA | ||||||||
OtherMiddleName: | DANIEL | ||||||||
OtherNamePrefix: | DR. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | D.O. | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 501 MADISON AVE | ||||||||
Address2: |   | ||||||||
City: | SCRANTON | ||||||||
State: | PA | ||||||||
PostalCode: | 185102401 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5703432383 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 301 S 7TH AVE STE 120 | ||||||||
Address2: |   | ||||||||
City: | WEST READING | ||||||||
State: | PA | ||||||||
PostalCode: | 196111449 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4846284630 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/18/2011 | ||||||||
LastUpdateDate: | 08/12/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 08/12/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | OS017485 | PA | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 207RI0200X | OS017485 | PA | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
No ID Information.