Provider Demographics
NPI:1003075094
Name:DI PASCUALE, MARIO ANTONIO (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIO
Middle Name:ANTONIO
Last Name:DI PASCUALE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2900 PERSHING DR
Mailing Address - Street 2:STE A
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79903-2483
Mailing Address - Country:US
Mailing Address - Phone:915-261-7011
Mailing Address - Fax:915-231-6822
Practice Address - Street 1:2900 PERSHING DR
Practice Address - Street 2:SUITE A
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79903-2403
Practice Address - Country:US
Practice Address - Phone:915-538-5171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-04
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN7917174400000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1285055905OtherGROUP NPI NUMBER