Provider Demographics
NPI:1336282870
Name:DIDARIO, A. GEOFFREY (MD)
Entity Type:Individual
Prefix:
First Name:A. GEOFFREY
Middle Name:
Last Name:DIDARIO
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 1:233 E LANCASTER AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ARDMORE
Mailing Address - State:PA
Mailing Address - Zip Code:19003-2321
Mailing Address - Country:US
Mailing Address - Phone:610-642-1643
Mailing Address - Fax:610-642-0245
Practice Address - Street 1:233 E LANCASTER AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:ARDMORE
Practice Address - State:PA
Practice Address - Zip Code:19003-2321
Practice Address - Country:US
Practice Address - Phone:610-642-1643
Practice Address - Fax:610-642-0245
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD426432207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA111467Medicare PIN