Provider Demographics
NPI:1750589875
Name:DIONISIO, DAVID (DO)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:DIONISIO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:477 COOPER RD STE 300
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-8057
Mailing Address - Country:US
Mailing Address - Phone:380-898-8808
Mailing Address - Fax:380-898-8842
Practice Address - Street 1:477 COOPER RD STE 300
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-8057
Practice Address - Country:US
Practice Address - Phone:380-898-8808
Practice Address - Fax:380-898-8842
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.128575207Q00000X
OH34.009651207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL900880OtherMEDICARE GROUP NUMBER (PTAN)