Provider Demographics
NPI:1811060098
Name:DICLEMENTE, DOMENIC D (MD)
Entity type:Individual
Prefix:
First Name:DOMENIC
Middle Name:D
Last Name:DICLEMENTE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1966 LINCOLN WAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WHITE OAK
Mailing Address - State:PA
Mailing Address - Zip Code:15131
Mailing Address - Country:US
Mailing Address - Phone:412-673-3800
Mailing Address - Fax:412-673-5848
Practice Address - Street 1:1966 LINCOLN WAY
Practice Address - Street 2:SUITE 100
Practice Address - City:WHITE OAK
Practice Address - State:PA
Practice Address - Zip Code:15131
Practice Address - Country:US
Practice Address - Phone:412-673-3800
Practice Address - Fax:412-673-5848
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD038834E207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
136255OtherMED PLUS
136255OtherMED PLUS
A75762Medicare UPIN