Provider Demographics
NPI:1114546736
Name:DICESARE ORTHOPEDIC MEDICINE LLC
Entity Type:Organization
Organization Name:DICESARE ORTHOPEDIC MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:A
Authorized Official - Last Name:DICESARE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-261-4080
Mailing Address - Street 1:PO BOX 7
Mailing Address - Street 2:
Mailing Address - City:BOVARD
Mailing Address - State:PA
Mailing Address - Zip Code:15619-0007
Mailing Address - Country:US
Mailing Address - Phone:724-261-4080
Mailing Address - Fax:412-261-4081
Practice Address - Street 1:438 PELLIS RD
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-7900
Practice Address - Country:US
Practice Address - Phone:724-261-4080
Practice Address - Fax:724-261-4081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-14
Last Update Date:2020-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Multi-Specialty