Healthcare Provider Details

I. General information

NPI: 1306051925
Provider Name (Legal Business Name): BERNARD JAMES DICASIMIRRO D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 HIGHLAND AVE
MORRISVILLE PA
19067-1073
US

IV. Provider business mailing address

825 HIGHLAND AVE
MORRISVILLE PA
19067-1073
US

V. Phone/Fax

Practice location:
  • Phone: 215-815-7851
  • Fax:
Mailing address:
  • Phone: 215-815-7851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License NumberOS007996L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: