Provider Demographics
NPI:1104818970
Name:DIB, EMIL (MD)
Entity type:Individual
Prefix:MR
First Name:EMIL
Middle Name:
Last Name:DIB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2265 MARKET ST
Mailing Address - Street 2:STE B
Mailing Address - City:WARREN
Mailing Address - State:PA
Mailing Address - Zip Code:16365-4682
Mailing Address - Country:US
Mailing Address - Phone:814-938-3343
Mailing Address - Fax:814-938-3369
Practice Address - Street 1:81 HILLCREST DR
Practice Address - Street 2:SUITE 2200
Practice Address - City:PUNXSUTAWNEY
Practice Address - State:PA
Practice Address - Zip Code:15767-2605
Practice Address - Country:US
Practice Address - Phone:814-938-3343
Practice Address - Fax:814-938-3369
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-18
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD064588L174400000X, 207V00000X
NJ25MA08096200207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017159730002Medicaid
PA021005UDLMedicare ID - Type Unspecified
PA0017159730002Medicaid