Provider Demographics
NPI:1730134974
Name:DIPPOLITO, ANTHONY D, (MD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:D,
Last Name:DIPPOLITO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:201 DRIFT COURT
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18020-7500
Mailing Address - Country:US
Mailing Address - Phone:610-882-9111
Mailing Address - Fax:610-882-9946
Practice Address - Street 1:1330 CENTER ST
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-2528
Practice Address - Country:US
Practice Address - Phone:610-882-9111
Practice Address - Fax:610-882-9946
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2017-07-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD023823E208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAC23083Medicare UPIN
PA153406Medicare ID - Type Unspecified