Provider Demographics
NPI:1992700900
Name:PURCELL, ROBERT E JR (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:E
Last Name:PURCELL
Suffix:JR
Gender:M
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:
Practice Address - Street 1:10 CHOATE CIR
Practice Address - Street 2:
Practice Address - City:MONTOURSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17754-9791
Practice Address - Country:US
Practice Address - Phone:570-368-5566
Practice Address - Fax:570-368-5564
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2020-08-26
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-03-31
Provider Licenses
StateLicense IDTaxonomies
PAMD035616E207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PACG0139OtherRAILRAOD MEDICARE
PA0010424900002Medicaid
PA103216Medicare ID - Type Unspecified
PACG0139OtherRAILRAOD MEDICARE
PA0010424900002Medicaid