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General NPI Number Information
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NPI Number | 1497721419
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Entity Type | Individual
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Provider Name | JOSEPH J DIBERNARDO PA-C
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Gender | Male
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Dates
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Enumeration Date | 02/28/2006
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Last Update Date | 12/02/2025
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Provider Practice Location Address
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Address Line | 164 SUMMIT AVE # C70
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City | PROVIDENCE
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State | RI
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Zip | 02906-2853
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Country | US
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Telephone | 401-793-4545
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Fax | 401-793-7866
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Provider Business Mailing Address
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Address Line | 15 LASALLE SQUARE
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City | PROVIDENCE
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State | RI
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Zip | 02903
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Country | US
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Telephone | 401-444-3239
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Fax |
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA00321
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License Number State | RI
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