1609879576 NPI number — DR. STEPHEN DIMARCO O.D.

Table of content: DR. STEPHEN DIMARCO O.D. (NPI 1609879576)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609879576 NPI number — DR. STEPHEN DIMARCO O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DIMARCO
Provider First Name:
STEPHEN
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
M

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:
1609879576
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/30/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9 MOUNT BETHEL PLZ
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOUNT BETHEL
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18343-5212
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-897-5911
Provider Business Mailing Address Fax Number:
570-897-5908

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9 MOUNT BETHEL PLZ
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNT BETHEL
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18343-5212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-897-5911
Provider Business Practice Location Address Fax Number:
570-897-5908
Provider Enumeration Date:
05/24/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  OEG000111 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 152W00000X , with the licence number: 27TO00002800 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152W00000X , with the licence number: 27OA00505400 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 02095801 . This is a "CAPITAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 02886800 . This is a "CAPITAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 751252 . This is a "KEYSTONE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: PA07149 . This is a "VISION BENEFITS OF AMERIC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 751252 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0727860001 . This is a "HEALTH NOW" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 232753266 . This is a "HORIZON" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 396396 . This is a "NAT'L. VISION ADMIN." identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 289678 . This is a "PRIVATE HEALTHCARE SYSTEM" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 465212 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 232753266 . This is a "VISION SERVICE PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1253981001 . This is a "CIGNA HEALTHCARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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