Provider Demographics
NPI:1508362278
Name:DEFELICE, DANIEL (DO)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:DEFELICE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:2550 MOSSIDE BLVD STE 500
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-3514
Mailing Address - Country:US
Mailing Address - Phone:412-457-1100
Mailing Address - Fax:412-457-0250
Practice Address - Street 1:2550 MOSSIDE BLVD STE 500
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-3514
Practice Address - Country:US
Practice Address - Phone:412-457-1100
Practice Address - Fax:412-457-0250
Is Sole Proprietor?:No
Enumeration Date:2018-04-02
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOS022218207QS0010X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine