Provider Demographics
NPI:1124241542
Name:SIMMONS, DELL E JR (MD)
Entity type:Individual
Prefix:
First Name:DELL
Middle Name:E
Last Name:SIMMONS
Suffix:JR
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4903
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:570-271-6578
Practice Address - Street 1:100 N ACADEMY AVE
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:PA
Practice Address - Zip Code:17822-3676
Practice Address - Country:US
Practice Address - Phone:570-271-6144
Practice Address - Fax:570-271-6578
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD449522207P00000X, 207RC0200X
NC2014-01238207P00000X
MDD0066108207P00000X, 2086S0102X
MDD661082086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDP00784514OtherRAILROAD MEDICARE
PA102848449Medicaid
MD415167400Medicaid
PA1623104OtherGATEWAY
PA420288OtherUPMC
PA002998792OtherHIGHMARK BLUE SHIELD
NC1124241542Medicaid
NC187MXOtherBCBS NC
MDP00784514OtherRAILROAD MEDICARE
MD138633ZAL4Medicare PIN
PA420288OtherUPMC