Healthcare Provider Details

I. General information

NPI: 1922171800
Provider Name (Legal Business Name): DOMINIC A CULOTTA M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 LANGHORNE-NEWTOWN ROAD SUITE 102
LANGHORNE PA
19047
US

IV. Provider business mailing address

275 E STREET RD
FEASTERVILLE TREVOSE PA
19053-6100
US

V. Phone/Fax

Practice location:
  • Phone: 267-689-1000
  • Fax: 267-689-1008
Mailing address:
  • Phone: 267-689-1000
  • Fax: 267-689-1008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number030244E
License Number StatePA

VIII. Authorized Official

Name: DR. JOHN TIMOTHY GALLAGHER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 267-689-1000