Provider Demographics
NPI:1205868866
Name:DEVITA, DENNIS M (MD)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:M
Last Name:DEVITA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:100 NORTH 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 1:310 ELECTRIC AVE
Practice Address - Street 2:SUITE 240
Practice Address - City:LEWISTOWN
Practice Address - State:PA
Practice Address - Zip Code:17044-1369
Practice Address - Country:US
Practice Address - Phone:717-248-5200
Practice Address - Fax:717-242-8125
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2020-08-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD19256E207XX0005X
PAMD019256E207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007712160001Medicaid
PA200002950OtherPALMETTO GBA
PA01026901OtherCAPITAL BLUE CROSS
PA147667OtherHIGHMARK BLUE SHIELD
PAB39780Medicare UPIN
PA01026901OtherCAPITAL BLUE CROSS