Healthcare Provider Details

I. General information

NPI: 1043412802
Provider Name (Legal Business Name): FRANK JOHN DAGOSTINO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 S GREENWOOD AVE
EASTON PA
18045-2547
US

IV. Provider business mailing address

100 S GREENWOOD AVE
EASTON PA
18045-2547
US

V. Phone/Fax

Practice location:
  • Phone: 610-258-7350
  • Fax: 610-258-3588
Mailing address:
  • Phone: 610-258-7350
  • Fax: 610-258-3588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD027150L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: