Provider Demographics
NPI:1073830923
Name:RICHARD DI MONTE DO PC
Entity type:Organization
Organization Name:RICHARD DI MONTE DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:DI MONTE
Authorized Official - Suffix:SR
Authorized Official - Credentials:DO
Authorized Official - Phone:215-724-7086
Mailing Address - Street 1:7418 BUIST AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19153-1403
Mailing Address - Country:US
Mailing Address - Phone:215-724-7086
Mailing Address - Fax:215-365-4029
Practice Address - Street 1:7418 BUIST AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19153-1403
Practice Address - Country:US
Practice Address - Phone:215-724-7086
Practice Address - Fax:215-365-4029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-30
Last Update Date:2010-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0596072Medicaid
PA0596072Medicaid
PA041867Medicare PIN