Provider Demographics
NPI:1790772937
Name:VISCO, DENISE M (MD)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:M
Last Name:VISCO
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 1:1880 KENNETH ROAD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17404
Mailing Address - Country:US
Mailing Address - Phone:717-767-2000
Mailing Address - Fax:717-767-2013
Practice Address - Street 1:1880 KENNETH ROAD
Practice Address - Street 2:SUITE 1
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17404
Practice Address - Country:US
Practice Address - Phone:717-767-2000
Practice Address - Fax:717-767-2013
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD056382L207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA07168407Medicaid
PA07168407Medicaid
PA796097PWHMedicare ID - Type Unspecified