Healthcare Provider Details

I. General information

NPI: 1356309462
Provider Name (Legal Business Name): HORACIO A HIDALGO JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 05/20/2021
Certification Date: 05/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4594 NEW FALLS ROAD SUITE A
LEVITTOWN PA
19056
US

IV. Provider business mailing address

41 UNIVERSITY DR SUITE 300
NEWTOWN PA
18940-1873
US

V. Phone/Fax

Practice location:
  • Phone: 267-587-3700
  • Fax: 215-949-2650
Mailing address:
  • Phone: 215-710-5522
  • Fax: 215-710-5181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD040685L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: