Provider Demographics
NPI:1851681605
Name:DIONALDO, CHRIS LEO DEOCAMPO
Entity Type:Individual
Prefix:
First Name:CHRIS LEO
Middle Name:DEOCAMPO
Last Name:DIONALDO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-812-3040
Mailing Address - Fax:717-812-3049
Practice Address - Street 1:2339 S GEORGE ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-5009
Practice Address - Country:US
Practice Address - Phone:717-812-3040
Practice Address - Fax:717-812-3049
Is Sole Proprietor?:No
Enumeration Date:2011-04-13
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PAOS017102208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102940150Medicaid
PA102940150Medicaid