Provider Demographics
NPI:1366427205
Name:GANDY, DANIEL R (DO)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:R
Last Name:GANDY
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:1660 SYCAMORE RD
Mailing Address - Street 2:SUIT C
Mailing Address - City:MONTOURSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17754-9314
Mailing Address - Country:US
Mailing Address - Phone:570-326-8080
Mailing Address - Fax:570-326-2733
Practice Address - Street 1:1660 SYCAMORE RD
Practice Address - Street 2:SUIT C
Practice Address - City:MONTOURSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17754-9314
Practice Address - Country:US
Practice Address - Phone:570-326-8080
Practice Address - Fax:570-326-2733
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2010-09-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAOS 003541L207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00998293Medicaid
PAE63627Medicare UPIN
PA00998293Medicaid