Provider Demographics
NPI:1669498861
Name:DITROLIO, ROBERT (DO)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:DITROLIO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 MEDICAL CENTER BLVD
Mailing Address - Street 2:SUITE 404
Mailing Address - City:UPLAND
Mailing Address - State:PA
Mailing Address - Zip Code:19013-3955
Mailing Address - Country:US
Mailing Address - Phone:610-619-8590
Mailing Address - Fax:610-619-8591
Practice Address - Street 1:30 MEDICAL CENTER BLVD
Practice Address - Street 2:SUITE 404
Practice Address - City:UPLAND
Practice Address - State:PA
Practice Address - Zip Code:19013-3955
Practice Address - Country:US
Practice Address - Phone:610-619-8590
Practice Address - Fax:610-619-8591
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2014-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS008262L207P00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1496492Medicaid
PA575197Medicare PIN
F95104Medicare UPIN