Provider Demographics
NPI:1245205608
Name:BISIO, PAUL W (DO)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:W
Last Name:BISIO
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-3034
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:570-271-6578
Practice Address - Street 1:21 COMMERCE CIR
Practice Address - Street 2:
Practice Address - City:MOUNT POCONO
Practice Address - State:PA
Practice Address - Zip Code:18344-1362
Practice Address - Country:US
Practice Address - Phone:570-839-3633
Practice Address - Fax:570-839-6490
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2016-03-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAOS009607L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001864580Medicaid
G16644Medicare UPIN
PA001864580Medicaid