Provider Demographics
NPI:1942885769
Name:DIBARTOLOMEO, ROBERT MARIO
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:MARIO
Last Name:DIBARTOLOMEO
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 1:320 IVY ROCK LN
Mailing Address - Street 2:
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-2721
Mailing Address - Country:US
Mailing Address - Phone:484-844-5242
Mailing Address - Fax:
Practice Address - Street 1:4601 LOCUST LN STE 202
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17109-4445
Practice Address - Country:US
Practice Address - Phone:717-526-2111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-12
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA14962225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist