Provider Demographics
NPI:1235347105
Name:HALEGOUA-DE MARZIO, DINA LOUISA (MD)
Entity Type:Individual
Prefix:DR
First Name:DINA
Middle Name:LOUISA
Last Name:HALEGOUA-DE MARZIO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:DINA
Other - Middle Name:LOUISA
Other - Last Name:HALEGOUA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:132 S 10TH ST
Mailing Address - Street 2:MAIN BUILDING, SUITE 480
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-5244
Mailing Address - Country:US
Mailing Address - Phone:215-955-8900
Mailing Address - Fax:215-503-2146
Practice Address - Street 1:132 S 10TH ST
Practice Address - Street 2:MAIN BUILDING, SUITE 480
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-5244
Practice Address - Country:US
Practice Address - Phone:215-955-8900
Practice Address - Fax:215-503-2146
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD442095207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology