Provider Demographics
NPI:1194405647
Name:PAYNE, DARLINE THOMAS
Entity type:Individual
Prefix:
First Name:DARLINE
Middle Name:THOMAS
Last Name:PAYNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:742 E PROVIDENCE RD
Mailing Address - Street 2:
Mailing Address - City:ALDAN
Mailing Address - State:PA
Mailing Address - Zip Code:19018-4317
Mailing Address - Country:US
Mailing Address - Phone:267-516-1831
Mailing Address - Fax:
Practice Address - Street 1:742 E PROVIDENCE RD
Practice Address - Street 2:
Practice Address - City:ALDAN
Practice Address - State:PA
Practice Address - Zip Code:19018-4317
Practice Address - Country:US
Practice Address - Phone:267-516-1831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-20
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0013374297251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health