Provider Demographics
NPI:1235190836
Name:SPOSITO, DIANE M (CRNP)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:M
Last Name:SPOSITO
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 ROUTE 6 AND 209
Mailing Address - Street 2:SUITE 8
Mailing Address - City:MILFORD
Mailing Address - State:PA
Mailing Address - Zip Code:18337-7615
Mailing Address - Country:US
Mailing Address - Phone:570-296-5950
Mailing Address - Fax:570-296-1066
Practice Address - Street 1:510 ROUTE 6 AND 209
Practice Address - Street 2:SUITE 8
Practice Address - City:MILFORD
Practice Address - State:PA
Practice Address - Zip Code:18337-7615
Practice Address - Country:US
Practice Address - Phone:570-296-5950
Practice Address - Fax:570-296-1066
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP008548207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101320947 0001Medicaid
NY02671061Medicaid
PA101320947 0001Medicaid
NY02671061Medicaid
PA090259XRUMedicare PIN
PA090259XRNMedicare PIN