MEDICARE: LUISITO DINGCONG

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

General Provider Information

NPI Number	:	1841282738
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUISITO DINGCONG

Provider Business Mailing Address
First Line	:	PO BOX 904
Second Line	:
City	:	ST MARYS
State	:	PA
Zip	:	15857-0904
Country	:	US
Telephone Number	:	814-781-3624
Fax Number	:	814-837-2713

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

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2005
Last Update Date	:	01/17/2014

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Directions to “ LUISITO DINGCONG ” Practice Location

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