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NPI Code Detail

MEDICARE: JOSEPH J DIBERNARDO PA-C

MEDICARE: JOSEPH J DIBERNARDO PA-C
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
1363AM0700XMedical Physician AssistantPA00321RI

General Provider Information

NPI Number : 1497721419
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOSEPH J DIBERNARDO PA-C
Provider Business Mailing Address
First Line : 15 LASALLE SQUARE
Second Line :
City : PROVIDENCE
State : RI
Zip : 02903
Country : US
Telephone Number : 401-444-3239
Fax Number :
Provider Business Practice Location Address
First Line : 164 SUMMIT AVE # C70
Second Line :
City : PROVIDENCE
State : RI
Zip : 02906-2853
Country : US
Telephone Number : 401-793-4545
Fax Number : 401-793-7866
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/28/2006
Last Update Date : 12/02/2025

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