Provider Demographics
NPI:1821154337
Name:DENNIS M. DEVITA, M.D. P.C.
Entity Type:Organization
Organization Name:DENNIS M. DEVITA, M.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:M
Authorized Official - Last Name:DEVITA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-242-0367
Mailing Address - Street 1:305 FOURT ST
Mailing Address - Street 2:PLEASANT ACRES
Mailing Address - City:LEWISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17044-1399
Mailing Address - Country:US
Mailing Address - Phone:717-242-0367
Mailing Address - Fax:717-242-0369
Practice Address - Street 1:305 FOURT ST
Practice Address - Street 2:PLEASANT ACRES
Practice Address - City:LEWISTOWN
Practice Address - State:PA
Practice Address - Zip Code:17044-1399
Practice Address - Country:US
Practice Address - Phone:717-242-0367
Practice Address - Fax:717-242-0369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD19256E207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA147667OtherHIGHMARK BLUE SHIELD
PA0007712160001Medicaid
PA03046400OtherCAPITAL BLUE CROSS
PA0007712160001Medicaid
PA147667Medicare ID - Type Unspecified