Provider Demographics
NPI:1063421287
Name:DURMIS, CHARLES H (DO)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:H
Last Name:DURMIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 YORK ST
Mailing Address - Street 2:
Mailing Address - City:CORRY
Mailing Address - State:PA
Mailing Address - Zip Code:16407
Mailing Address - Country:US
Mailing Address - Phone:814-663-3030
Mailing Address - Fax:814-663-3040
Practice Address - Street 1:328 YORK ST
Practice Address - Street 2:
Practice Address - City:CORRY
Practice Address - State:PA
Practice Address - Zip Code:16407
Practice Address - Country:US
Practice Address - Phone:814-663-3030
Practice Address - Fax:814-663-3040
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0S007151L208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019002100004Medicaid
PA0019002100004Medicaid
F76149Medicare UPIN