Healthcare Provider Details

I. General information

NPI: 1245205608
Provider Name (Legal Business Name): PAUL W. BISIO D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 03/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 COMMERCE CIR
MOUNT POCONO PA
18344-1362
US

IV. Provider business mailing address

100 N ACADEMY AVE
DANVILLE PA
17822-3034
US

V. Phone/Fax

Practice location:
  • Phone: 570-839-3633
  • Fax: 570-839-6490
Mailing address:
  • Phone: 570-271-6144
  • Fax: 570-271-6578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS009607L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: