Provider Demographics
NPI:1548235740
Name:DESIO, FELIX JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:FELIX
Middle Name:JOSEPH
Last Name:DESIO
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 1:1 GUTHRIE SQ
Mailing Address - Street 2:
Mailing Address - City:SAYRE
Mailing Address - State:PA
Mailing Address - Zip Code:18840-1625
Mailing Address - Country:US
Mailing Address - Phone:570-888-5858
Mailing Address - Fax:
Practice Address - Street 1:1 GUTHRIE SQ
Practice Address - Street 2:
Practice Address - City:SAYRE
Practice Address - State:PA
Practice Address - Zip Code:18840-1625
Practice Address - Country:US
Practice Address - Phone:570-888-5858
Practice Address - Fax:570-887-2699
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD024192E207RN0300X
NY162019-1207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PACC9269OtherRR MEDICARE GROUP
NY00853489Medicaid
PAGU040072OtherMEDICARE GROUP
PA0009657010001Medicaid
PA390007793OtherRR MEDICARE PIN
PA390007793OtherRR MEDICARE PIN
C28866Medicare UPIN
PA068579N92Medicare ID - Type Unspecified