Healthcare Provider Details

I. General information

NPI: 1548235740
Provider Name (Legal Business Name): FELIX JOSEPH DESIO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 06/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 GUTHRIE SQ
SAYRE PA
18840-1625
US

IV. Provider business mailing address

1 GUTHRIE SQ
SAYRE PA
18840-1625
US

V. Phone/Fax

Practice location:
  • Phone: 570-888-5858
  • Fax: 570-887-2699
Mailing address:
  • Phone: 570-888-5858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberMD024192E
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number162019-1
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierCC9269
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerRR MEDICARE GROUP
# 2
Identifier00853489
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer
# 3
IdentifierGU040072
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerMEDICARE GROUP
# 4
Identifier0009657010001
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 5
Identifier390007793
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerRR MEDICARE PIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: