Provider Demographics
NPI:1811563109
Name:DIVITO, ALEC JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEC
Middle Name:JAMES
Last Name:DIVITO
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 1:1700 ST. LUKE'S BLVD.
Mailing Address - Street 2:SUITE 402
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18045
Mailing Address - Country:US
Mailing Address - Phone:484-503-3000
Mailing Address - Fax:484-503-3071
Practice Address - Street 1:1700 ST. LUKE'S BLVD.
Practice Address - Street 2:SUITE 402
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18045
Practice Address - Country:US
Practice Address - Phone:484-503-3000
Practice Address - Fax:484-503-3071
Is Sole Proprietor?:No
Enumeration Date:2021-05-27
Last Update Date:2022-07-15
Deactivation Date:2022-06-16
Deactivation Code:
Reactivation Date:2022-07-14
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program