Provider Demographics
NPI:1568561702
Name:DISIPIO, LORRAINE M (DO)
Entity Type:Individual
Prefix:
First Name:LORRAINE
Middle Name:M
Last Name:DISIPIO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 LANSDOWNE AVE FL 1
Mailing Address - Street 2:
Mailing Address - City:DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19023-1333
Mailing Address - Country:US
Mailing Address - Phone:610-534-6310
Mailing Address - Fax:610-534-6350
Practice Address - Street 1:1501 LANSDOWNE AVE FL 1
Practice Address - Street 2:
Practice Address - City:DARBY
Practice Address - State:PA
Practice Address - Zip Code:19023-1333
Practice Address - Country:US
Practice Address - Phone:610-534-6310
Practice Address - Fax:610-534-6350
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS004216L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2451661000OtherHIGHMARK BLUE SHIELD
PA94214Medicare ID - Type Unspecified
PA2451661000OtherHIGHMARK BLUE SHIELD