Provider Demographics
NPI:1386328268
Name:GERMINAL, DERVINS
Entity type:Individual
Prefix:
First Name:DERVINS
Middle Name:
Last Name:GERMINAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 HAWK RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:PA
Mailing Address - Zip Code:19526-9219
Mailing Address - Country:US
Mailing Address - Phone:610-562-3066
Mailing Address - Fax:610-562-3125
Practice Address - Street 1:700 HAWK RIDGE DR
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:PA
Practice Address - Zip Code:19526-9219
Practice Address - Country:US
Practice Address - Phone:610-562-3066
Practice Address - Fax:610-562-3125
Is Sole Proprietor?:No
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program