Provider Demographics
NPI:1134104029
Name:DILEONARDO, MARIO (MD)
Entity Type:Individual
Prefix:MR
First Name:MARIO
Middle Name:
Last Name:DILEONARDO
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 1:14275 MIDWAY RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-3614
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:610-271-4245
Practice Address - Street 1:3805 W CHESTER PIKE BLDG D
Practice Address - Street 2:SUITE 120
Practice Address - City:NEWTOWN SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19073-2329
Practice Address - Country:US
Practice Address - Phone:800-257-0117
Practice Address - Fax:610-550-3079
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD037056E207N00000X, 207ZP0101X, 207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B38557Medicare UPIN