Active NPI
Daniel J Maydonovitch, DO
- Family Medicine Physician
- Boyertown, PA
National Provider Identifier
1154396802
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- OS007688L
- Practice address
- 23 N Walnut St
Boyertown, PA 19512-1467 - Phone
- (610) 367-2259
- Fax
- (610) 367-0505
- NPI assigned
- Feb 17, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | OS007688L | PA | Primary |
Addresses
Primary practice location
23 N Walnut St
Boyertown, PA 19512-1467
Mailing address
23 N Walnut St
Boyertown, PA 19512-1467
Phone (610) 367-2259
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OS007688L | PA | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1140134400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1547942400000",
"number": "1154396802",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "23 N WALNUT ST",
"city": "BOYERTOWN",
"state": "PA",
"postal_code": "195121467",
"telephone_number": "610-367-2259",
"fax_number": "610-367-0505"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "23 N WALNUT ST",
"city": "BOYERTOWN",
"state": "PA",
"postal_code": "195121467",
"telephone_number": "610-367-2259",
"fax_number": "610-367-0505"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAYDONOVITCH",
"first_name": "DANIEL",
"middle_name": "J",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-02-17",
"last_updated": "2019-01-20",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "PA",
"license": "OS007688L",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boyertown, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.