Healthcare Provider Details

I. General information

NPI: 1073583902
Provider Name (Legal Business Name): MARK A DIPILLO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 08/09/2021
Certification Date: 08/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2630 WESTVIEW DR
WYOMISSING PA
19610-1130
US

IV. Provider business mailing address

2630 WESTVIEW DR
WYOMISSING PA
19610-1130
US

V. Phone/Fax

Practice location:
  • Phone: 610-376-1981
  • Fax: 610-376-3153
Mailing address:
  • Phone: 610-376-1981
  • Fax: 610-376-3153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD044541E
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number288686
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code207WX0009X
TaxonomyGlaucoma Specialist (Ophthalmology) Physician
License NumberMD044541E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: