Healthcare Provider Details

I. General information

NPI: 1801086251
Provider Name (Legal Business Name): ANTHONY DIPPOLITO, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2007
Last Update Date: 07/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 DRIFT CT
BETHLEHEM PA
18020-7500
US

IV. Provider business mailing address

201 DRIFT CT
BETHLEHEM PA
18020-7500
US

V. Phone/Fax

Practice location:
  • Phone: 610-882-9111
  • Fax: 610-882-9946
Mailing address:
  • Phone: 610-882-9111
  • Fax: 610-882-9946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD0323823E
License Number StatePA

VIII. Authorized Official

Name: DR. ANTHONY D DIPPOLITO
Title or Position: PRESIDENT
Credential: M.D.
Phone: 610-882-9111