Basic Information
Provider Information | |||||||||
NPI: | 1689618399 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | DUFENDACH | ||||||||
FirstName: | JOHN | ||||||||
MiddleName: | H. | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1803 MOUNT ROSE AVE | ||||||||
Address2: | STE B3 | ||||||||
City: | YORK | ||||||||
State: | PA | ||||||||
PostalCode: | 174033026 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7178511405 | ||||||||
FaxNumber: | 7178516969 | ||||||||
Practice Location | |||||||||
Address1: | 147 GETTYS ST | ||||||||
Address2: |   | ||||||||
City: | GETTYSBURG | ||||||||
State: | PA | ||||||||
PostalCode: | 173252534 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7173374216 | ||||||||
FaxNumber: | 7173374249 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/15/2006 | ||||||||
LastUpdateDate: | 10/30/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | MD025315E | PA | Y |   | Allopathic & Osteopathic Physicians | Emergency Medicine |   | 207Q00000X | MD025315E | PA | N |   | Allopathic & Osteopathic Physicians | Family Medicine |   |
ID Information
ID | Type | State | Issuer | Description | 20016175 | 01 | PA | AMERIHEALTH MERCY GH | OTHER | 181476 | 01 | PA | HIGHMARK GH | OTHER | 1521176 | 01 | PA | GATEWAY-GH | OTHER | 50067127 | 01 | PA | CAPITAL BLUE CROSS GH | OTHER | 114445 | 01 | PA | UNISON GH | OTHER | 0010074000 | 01 | PA | AMERIHEALTH 65 PA GH | OTHER | 24299 | 01 | PA | GEISINGER-GH | OTHER |