Provider Demographics
NPI:1083618029
Name:DESIMONE, SALVATORE (DO)
Entity Type:Individual
Prefix:MR
First Name:SALVATORE
Middle Name:
Last Name:DESIMONE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5001 FRANKFORD AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19124-2619
Mailing Address - Country:US
Mailing Address - Phone:215-288-5000
Mailing Address - Fax:215-744-1233
Practice Address - Street 1:5001 FRANKFORD AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19124-2619
Practice Address - Country:US
Practice Address - Phone:215-288-5000
Practice Address - Fax:215-744-1233
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0S007669L207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA576732OtherAETNA
PA730706OtherHIGHMARK BLUE SHIELD
PA001574534004Medicaid
PA730706OtherBLUE SHEILD
PA10871OtherHEALTHGUARD
PA0573185000OtherKEYSTONE EAST
PA990026OtherKEYSTONE HEALTH PLAN L
PA1040332OtherAMERIHEALTH
PA180028017OtherRAILROAD MEDICARE
PA27541OtherHEALTH AMERICA
PA7990026OtherGATEWAY
PA0573185000OtherKEYSTONE EAST
PA001574534004Medicaid