Provider Demographics
NPI:1336101484
Name:DEIBERT, PHILIP W (DO)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:W
Last Name:DEIBERT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:PHILIP
Other - Middle Name:W
Other - Last Name:DEIBERT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:1205 LANGHORNE NEWTOWN RD
Mailing Address - Street 2:#308
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-1219
Mailing Address - Country:US
Mailing Address - Phone:215-757-8178
Mailing Address - Fax:215-757-4600
Practice Address - Street 1:1205 LANGHORNE NEWTOWN RD
Practice Address - Street 2:#308
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-1219
Practice Address - Country:US
Practice Address - Phone:215-757-8178
Practice Address - Fax:215-757-4600
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-04
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA003094L207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA107802Medicare ID - Type Unspecified
B36722Medicare UPIN