Provider Demographics
NPI:1073574257
Name:DIDUSZYN, JORGE M (MD)
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:M
Last Name:DIDUSZYN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-4219
Mailing Address - Country:US
Mailing Address - Phone:717-264-5433
Mailing Address - Fax:717-264-3279
Practice Address - Street 1:840 5TH AVE
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-4219
Practice Address - Country:US
Practice Address - Phone:717-264-5433
Practice Address - Fax:717-264-3784
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD427818207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001809814OtherHIGHMARK BCBS
I50385Medicare UPIN
PA099045Medicare PIN