Provider Demographics
NPI:1922171800
Name:DOMINIC A CULOTTA M.D., P.C.
Entity Type:Organization
Organization Name:DOMINIC A CULOTTA M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:TIMOTHY
Authorized Official - Last Name:GALLAGHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:267-689-1000
Mailing Address - Street 1:275 E STREET RD
Mailing Address - Street 2:
Mailing Address - City:FEASTERVILLE TREVOSE
Mailing Address - State:PA
Mailing Address - Zip Code:19053-6100
Mailing Address - Country:US
Mailing Address - Phone:267-689-1000
Mailing Address - Fax:267-689-1008
Practice Address - Street 1:1205 LANGHORNE-NEWTOWN ROAD
Practice Address - Street 2:SUITE 102
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047
Practice Address - Country:US
Practice Address - Phone:267-689-1000
Practice Address - Fax:267-689-1008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA030244E207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & NeckGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAE39596Medicare UPIN