MEDICARE: LUISITO S DINGCONG MD PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	MD052607L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	100298	OTHER	PA	BLUE SHIELD

General Provider Information

NPI Number	:	1396968871
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LUISITO S DINGCONG MD PC

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

Provider Business Practice Location Address
First Line	:	1033 TURNPIKE AVE
Second Line	:
City	:	CLEARFIELD
State	:	PA
Zip	:	16830-3061
Country	:	US
Telephone Number	:	814-765-2137
Fax Number	:	814-768-2084

Authorized Official
Title or Position	:	MD
Name	:	DR. LUISITO S. DINGCONG
Credential	:	MD
Telephone Number	:	814-834-9670

Provider Enumeration Date	:	04/11/2007
Last Update Date	:	01/28/2014

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