Provider Demographics
NPI:1457335192
Name:FIORDIMONDO, ANGELO J (PHD)
Entity Type:Individual
Prefix:
First Name:ANGELO
Middle Name:J
Last Name:FIORDIMONDO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-339-2710
Mailing Address - Fax:717-339-2711
Practice Address - Street 1:40 V TWIN DR
Practice Address - Street 2:STE 202
Practice Address - City:GETTYSBURG
Practice Address - State:PA
Practice Address - Zip Code:17325-1926
Practice Address - Country:US
Practice Address - Phone:717-339-2710
Practice Address - Fax:717-339-2711
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS006503L103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA975828OtherBLUE SHIELD
PA023105Medicare PIN
PA975828OtherBLUE SHIELD