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General NPI Number Information
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NPI Number | 1184862427
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Entity Type | Individual
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Provider Name | JACOB A DICESARE DO
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Gender | Male
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Dates
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Enumeration Date | 01/24/2009
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Last Update Date | 09/08/2020
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Provider Practice Location Address
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Address Line | 438 PELLIS RD
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City | GREENSBURG
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State | PA
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Zip | 15601-7900
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Country | US
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Telephone | 724-261-4080
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Fax | 724-261-4081
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Provider Business Mailing Address
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Address Line | PO BOX 7
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City | BOVARD
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State | PA
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Zip | 15619-0007
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Country | US
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Telephone | 724-261-4080
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Fax | 724-261-4081
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | OS014434
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License Number State | PA
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