Provider Demographics
NPI:1538666789
Name:JOSEPH A. DICONCETTO, MD, PC
Entity Type:Organization
Organization Name:JOSEPH A. DICONCETTO, MD, PC
Other - Org Name:JOSEPH A. DICONCETTO, MD
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:DICONCETTO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-691-2221
Mailing Address - Street 1:5325 NORTHGATE DR STE 104
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017-9412
Mailing Address - Country:US
Mailing Address - Phone:610-691-2221
Mailing Address - Fax:610-865-5655
Practice Address - Street 1:5325 NORTHGATE DR STE 104
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-9412
Practice Address - Country:US
Practice Address - Phone:610-691-2221
Practice Address - Fax:610-865-5655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-12
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD025018E207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & ImmunologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0070653750002Medicaid