MEDICARE: DR. MARIO ANTONIO DI PASCUALE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	N7917	TX
2	207W00000X	Ophthalmology Physician	N7917	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1285055905	OTHER	TX	GROUP NPI NUMBER

General Provider Information

NPI Number	:	1003075094
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARIO ANTONIO DI PASCUALE MD

Provider Business Mailing Address
First Line	:	2900 PERSHING DR
Second Line	:	STE A
City	:	EL PASO
State	:	TX
Zip	:	79903-2483
Country	:	US
Telephone Number	:	915-261-7011
Fax Number	:	915-231-6822

Provider Business Practice Location Address
First Line	:	2900 PERSHING DR
Second Line	:	SUITE A
City	:	EL PASO
State	:	TX
Zip	:	79903-2403
Country	:	US
Telephone Number	:	915-538-5171
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/04/2008
Last Update Date	:	04/21/2016

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Directions to “ DR. MARIO ANTONIO DI PASCUALE MD” Practice Location

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