Provider Demographics
NPI:1275580748
Name:DICROCE, JOSEPH NICHOLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:NICHOLAS
Last Name:DICROCE
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:PO BOX 314
Mailing Address - Street 2:
Mailing Address - City:PENN
Mailing Address - State:PA
Mailing Address - Zip Code:15675-0314
Mailing Address - Country:US
Mailing Address - Phone:412-682-3209
Mailing Address - Fax:412-682-3464
Practice Address - Street 1:117 FOX PLAN RD STE 302
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-2723
Practice Address - Country:US
Practice Address - Phone:412-682-3209
Practice Address - Fax:412-682-3464
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-28
Last Update Date:2015-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA032169E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010710520007Medicaid
PA0010710520007Medicaid
PA175597Medicare PIN
PAB40710Medicare UPIN