Provider Demographics
NPI:1821005687
Name:DIGREGORIO, EILEEN ROSE (DO)
Entity Type:Individual
Prefix:DR
First Name:EILEEN
Middle Name:ROSE
Last Name:DIGREGORIO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4802 NESHAMINY BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-1041
Mailing Address - Country:US
Mailing Address - Phone:215-741-1180
Mailing Address - Fax:215-741-6412
Practice Address - Street 1:4802 NESHAMINY BLVD STE 1
Practice Address - Street 2:
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020-1041
Practice Address - Country:US
Practice Address - Phone:215-741-1180
Practice Address - Fax:215-741-6412
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS005845L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA7017799Medicaid
PAB41489Medicare UPIN
PA7017799Medicaid