Provider Demographics
NPI:1689659922
Name:DIPIETRO, DAVID E (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:E
Last Name:DIPIETRO
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 1:2325 HERITAGE CENTER DRIVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FURLONG
Mailing Address - State:PA
Mailing Address - Zip Code:18925
Mailing Address - Country:US
Mailing Address - Phone:267-247-5100
Mailing Address - Fax:267-406-4423
Practice Address - Street 1:2325 HERITAGE CENTER DRIVE
Practice Address - Street 2:SUITE 200
Practice Address - City:FURLONG
Practice Address - State:PA
Practice Address - Zip Code:18925
Practice Address - Country:US
Practice Address - Phone:267-247-5100
Practice Address - Fax:267-406-4423
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD036548E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001188289Medicaid
PAE52799Medicare UPIN
PA430126JZWMedicare ID - Type Unspecified