Provider Demographics
NPI:1417921636
Name:DVORKIN, DANIEL (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:
Last Name:DVORKIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:319 N POTTSTOWN PIKE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-2218
Mailing Address - Country:US
Mailing Address - Phone:215-305-8834
Mailing Address - Fax:610-363-2026
Practice Address - Street 1:319 N POTTSTOWN PIKE
Practice Address - Street 2:SUITE 102
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-2218
Practice Address - Country:US
Practice Address - Phone:215-305-8834
Practice Address - Fax:610-363-2026
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD010365E207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103114349Medicaid
PA103114349Medicaid
PA137251ZJB3Medicare PIN
PA082894Medicare PIN