Provider Demographics
NPI:1245341171
Name:DIPAOLO, PATRICK J (MD)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:J
Last Name:DIPAOLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:781 BLOOMFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-1806
Mailing Address - Country:US
Mailing Address - Phone:973-744-7979
Mailing Address - Fax:973-744-8120
Practice Address - Street 1:781 BLOOMFIELD AVE
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-1806
Practice Address - Country:US
Practice Address - Phone:973-744-7979
Practice Address - Fax:973-744-8120
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04681700207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ633186OtherMEDICARE PTAN
NJ5011604Medicaid
NJ633186OtherMEDICARE PTAN