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General NPI Number Information
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NPI Number | 1609849934
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Entity Type | Individual
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Provider Name | RICHARD D. DIBACCO DPM
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Gender | Male
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Dates
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Enumeration Date | 02/08/2006
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Last Update Date | 06/30/2010
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Provider Practice Location Address
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Address Line | 4402 PEACH ST
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City | ERIE
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State | PA
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Zip | 16509-1358
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Country | US
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Telephone | 814-864-4874
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Fax | 814-864-4877
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Provider Business Mailing Address
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Address Line | 4402 PEACH ST
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City | ERIE
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State | PA
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Zip | 16509-1358
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Country | US
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Telephone | 814-864-4874
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Fax | 814-864-4877
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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 | 213EP1101X
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Taxonomy Name | Primary Podiatric Medicine Podiatrist
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License Number | SC001282L
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 213ER0200X
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Taxonomy Name | Radiology Podiatrist
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License Number | SC001282L
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | SC001282L
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License Number State | PA
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Taxonomy #4
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Taxonomy Code | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number | SC001282L
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License Number State | PA
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