Healthcare Provider Details

I. General information

NPI: 1235347105
Provider Name (Legal Business Name): DINA LOUISA HALEGOUA-DE MARZIO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DINA LOUISA HALEGOUA M.D.

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 10/28/2024
Certification Date: 10/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 CHESTNUT ST
PHILADELPHIA PA
19107-3612
US

IV. Provider business mailing address

132 S 10TH ST MAIN BUILDING, SUITE 480
PHILADELPHIA PA
19107-5244
US

V. Phone/Fax

Practice location:
  • Phone: 215-955-8900
  • Fax: 215-955-5245
Mailing address:
  • Phone: 215-955-8900
  • Fax: 215-503-2146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD442095
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: