Provider Demographics
NPI:1710417480
Name:D'URSO, ANTONIETTA (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTONIETTA
Middle Name:
Last Name:D'URSO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 W LINCOLN HWY
Mailing Address - Street 2:
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-2514
Mailing Address - Country:US
Mailing Address - Phone:610-269-9966
Mailing Address - Fax:
Practice Address - Street 1:650 W LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-2514
Practice Address - Country:US
Practice Address - Phone:610-269-9966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-15
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD471913208000000X
PAMT2198352080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics