Healthcare Provider Details

I. General information

NPI: 1679552418
Provider Name (Legal Business Name): JOSEPH A DICONCETTO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2006
Last Update Date: 01/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5325 NORTHGATE DR SUITE 104
BETHLEHEM PA
18017-9411
US

IV. Provider business mailing address

1999 W POINT DR
BETHLEHEM PA
18015-5156
US

V. Phone/Fax

Practice location:
  • Phone: 610-691-2221
  • Fax: 610-865-5655
Mailing address:
  • Phone: 610-691-2221
  • Fax: 610-865-5655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberMD025018E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: