Provider Demographics
NPI:1881812527
Name:DICASIMIRRO, JOHN ARTHUR (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ARTHUR
Last Name:DICASIMIRRO
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 1:11 ORCHARD PL
Mailing Address - Street 2:
Mailing Address - City:BERNVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19506-9586
Mailing Address - Country:US
Mailing Address - Phone:610-781-2964
Mailing Address - Fax:610-488-6377
Practice Address - Street 1:11 ORCHARD PL
Practice Address - Street 2:
Practice Address - City:BERNVILLE
Practice Address - State:PA
Practice Address - Zip Code:19506-9586
Practice Address - Country:US
Practice Address - Phone:610-781-2964
Practice Address - Fax:610-488-6377
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD042948L207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAE94499Medicare UPIN