Active NPI
John A. Daller, MD, PHD
- Surgery Physician
- Upland, PA
National Provider Identifier
1831294578
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- MD058852L
- Practice address
- 30 Medical Center Blvd
Suite 200
Upland, PA 19013 - Phone
- (610) 619-8420
- Fax
- (610) 619-8421
- NPI assigned
- Sep 14, 2006
- Last updated
- Feb 6, 2013
- 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 |
|---|---|---|---|---|
| Surgery Physician | 208600000X | MD058852L | PA | Primary |
Addresses
Primary practice location
30 Medical Center Blvd
Suite 200
Upland, PA 19013
Mailing address
30 Medical Center Blvd
Suite 200
Upland, PA 19013
Phone (610) 619-8420
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1017210240001 | Medicaid | PA |
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 Medicine, Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD058852L | PA | MD | Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ozarks Medical Center | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Ozarks Healthcare
- General Acute Care Hospital
- West Plains, MO
- NPI 1831115641
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158192000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1360108800000",
"number": "1831294578",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "30 MEDICAL CENTER BLVD",
"address_2": "SUITE 200",
"city": "UPLAND",
"state": "PA",
"postal_code": "19013",
"telephone_number": "610-619-8420",
"fax_number": "610-619-8421"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "30 MEDICAL CENTER BLVD",
"address_2": "SUITE 200",
"city": "UPLAND",
"state": "PA",
"postal_code": "19013",
"telephone_number": "610-619-8420",
"fax_number": "610-619-8421"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DALLER",
"first_name": "JOHN",
"middle_name": "A.",
"name_prefix": "Mr.",
"credential": "MD, PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-14",
"last_updated": "2013-02-06",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "PA",
"license": "MD058852L",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1017210240001",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Upland, PA
- Crozer-Chester Medical Center
- Crozer-Chester Medical Center (CrozerTaylorSpringfield)
- Crozer-Chester Medical Center (CrozerTaylorSpringfield)
- Crozer-Chester Medical Center
- Maureen Cuesta, CRNA
- Leamon L. Davenport, DO
- Christina Davidyock, CRNP
- Tina Marie Deangelis, EDE, OTR/L
- Delaware County Urological Associates, LTD
- Sharon T. Denny, M.D.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.