Provider Demographics
NPI:1053309385
Name:DILIBERTO, THOMAS A (DO)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:A
Last Name:DILIBERTO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:501 N LANSDOWNE AVE
Mailing Address - Street 2:DCMH
Mailing Address - City:DREXEL HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19026-1114
Mailing Address - Country:US
Mailing Address - Phone:610-394-1735
Mailing Address - Fax:610-284-8312
Practice Address - Street 1:501 N LANSDOWNE AVE
Practice Address - Street 2:
Practice Address - City:DREXEL HILL
Practice Address - State:PA
Practice Address - Zip Code:19026-1114
Practice Address - Country:US
Practice Address - Phone:610-394-1735
Practice Address - Fax:610-284-8312
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-11
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS002313L2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B37470Medicare UPIN
PA127886Medicare PIN