Healthcare Provider Details

I. General information

NPI: 1255302246
Provider Name (Legal Business Name): LOUIS C. CIMORELLI JR. D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 10/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4379 EASTON AVE SUITE 101
BETHLEHEM PA
18020-1483
US

IV. Provider business mailing address

801 OSTRUM ST
BETHLEHEM PA
18015-1000
US

V. Phone/Fax

Practice location:
  • Phone: 610-814-2424
  • Fax: 610-814-2425
Mailing address:
  • Phone: 484-526-6048
  • Fax: 484-526-6500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0102201477
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number240013
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS015344
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: