Provider Demographics
NPI:1932286051
Name:RISPOLI, DAMIAN MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:DAMIAN
Middle Name:MARK
Last Name:RISPOLI
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 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4903
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:570-271-6578
Practice Address - Street 1:4230 CRUMS MILL RD.
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17110-8853
Practice Address - Country:US
Practice Address - Phone:717-233-6171
Practice Address - Fax:717-233-7880
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC55049207XS0114X
PAMD435644207XS0114X, 207X00000X
WV22964207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA30112259OtherAMERIHEALTH MERCY-WMG WSO-Y
PA050918300Medicaid
PA102232400Medicaid
PA1578376OtherGATEWAY
PA2073140OtherHIGHMARK BLUE SHIELD
PA30112255OtherAMERIHEALTH MERCY-WMG WSO-G
PA418073OtherUPMC
PA30112259OtherAMERIHEALTH MERCY-WMG WSO-Y
PA30112255OtherAMERIHEALTH MERCY-WMG WSO-G
PA418073OtherUPMC
PA102232400Medicaid
PA142596FLTMedicare PIN