Provider Demographics
NPI:1104844497
Name:POLICASTRO, DENNIS (MD)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:
Last Name:POLICASTRO
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 1:700 SPRUCE STREET
Mailing Address - Street 2:SUITE 304
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-4023
Mailing Address - Country:US
Mailing Address - Phone:215-829-3521
Mailing Address - Fax:215-829-3532
Practice Address - Street 1:700 SPRUCE STREET
Practice Address - Street 2:SUITE 304
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106-4023
Practice Address - Country:US
Practice Address - Phone:215-829-3521
Practice Address - Fax:215-829-3532
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD027987E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001051050Medicaid
PAA59911Medicare UPIN
PA198980Medicare ID - Type Unspecified