Healthcare Provider Details

I. General information

NPI: 1407007156
Provider Name (Legal Business Name): THERESA DIMAGGIO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2008
Last Update Date: 09/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34TH ST AND CIVIC CENTER BLVD
PHILADELPHIA PA
19104
US

IV. Provider business mailing address

34TH ST AND CIVIC CENTER BLVD CHILDREN'S HOSPITAL OF PHILADELPHIA
PHILADELPHIA PA
19104
US

V. Phone/Fax

Practice location:
  • Phone: 215-590-4926
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN 266488L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: