MEDICARE: DR. DAMIAN MARK RISPOLI 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	207XS0114X	Adult Reconstructive Orthopaedic Surgery Physician	MD435644	PA
2	207X00000X	Orthopaedic Surgery Physician	MD435644	PA
3	207X00000X	Orthopaedic Surgery Physician	22964	WV
4	207XS0114X	Adult Reconstructive Orthopaedic Surgery Physician	55049	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	30112259	OTHER	PA	AMERIHEALTH MERCY-WMG WSO-Y
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	1578376	OTHER	PA	GATEWAY
5	2073140	OTHER	PA	HIGHMARK BLUE SHIELD
6	30112255	OTHER	PA	AMERIHEALTH MERCY-WMG WSO-G
7	418073	OTHER	PA	UPMC

General Provider Information

NPI Number	:	1932286051
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAMIAN MARK RISPOLI MD

Provider Business Mailing Address
First Line	:	120 CHARLES ROLLINS RD STE 120
Second Line	:
City	:	HENDERSON
State	:	NC
Zip	:	27536-2882
Country	:	US
Telephone Number	:
Fax Number	:	570-271-6578

Provider Business Practice Location Address
First Line	:	4230 CRUMS MILL RD.
Second Line	:
City	:	HARRISBURG
State	:	PA
Zip	:	17110-8853
Country	:	US
Telephone Number	:	717-233-6171
Fax Number	:	717-233-7880

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

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	06/03/2026

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