1396968871 NPI number — LUISITO S DINGCONG MD PC

Table of content: (NPI 1396968871)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396968871 NPI number — LUISITO S DINGCONG MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LUISITO S DINGCONG MD PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396968871
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/28/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 904
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT MARYS
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15857-0904
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-834-9670
Provider Business Mailing Address Fax Number:
814-834-1855

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1033 TURNPIKE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLEARFIELD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16830-3061
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-765-2137
Provider Business Practice Location Address Fax Number:
814-768-2084
Provider Enumeration Date:
04/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DINGCONG
Authorized Official First Name:
LUISITO
Authorized Official Middle Name:
S.
Authorized Official Title or Position:
MD
Authorized Official Telephone Number:
814-834-9670

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  MD052607L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0014738630006 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100298 . This is a "BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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