Provider Demographics
NPI:1396968871
Name:LUISITO S DINGCONG MD PC
Entity type:Organization
Organization Name:LUISITO S DINGCONG MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:LUISITO
Authorized Official - Middle Name:S
Authorized Official - Last Name:DINGCONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-834-9670
Mailing Address - Street 1:PO BOX 904
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:PA
Mailing Address - Zip Code:15857-0904
Mailing Address - Country:US
Mailing Address - Phone:814-834-9670
Mailing Address - Fax:814-834-1855
Practice Address - Street 1:1033 TURNPIKE AVE
Practice Address - Street 2:
Practice Address - City:CLEARFIELD
Practice Address - State:PA
Practice Address - Zip Code:16830-3061
Practice Address - Country:US
Practice Address - Phone:814-765-2137
Practice Address - Fax:814-768-2084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD052607L2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0014738630006Medicaid
PA100298OtherBLUE SHIELD
PA100298OtherBLUE SHIELD
PA109751Medicare PIN