Provider Demographics
NPI:1194702076
Name:DILEO, DOMINIC WILLIAM (MD)
Entity type:Individual
Prefix:DR
First Name:DOMINIC
Middle Name:WILLIAM
Last Name:DILEO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 SIMPSON RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:BROWNSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15417-8622
Mailing Address - Country:US
Mailing Address - Phone:724-785-7080
Mailing Address - Fax:724-785-5048
Practice Address - Street 1:127 SIMPSON RD STE C
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15417-8622
Practice Address - Country:US
Practice Address - Phone:724-785-7080
Practice Address - Fax:724-785-5048
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-30
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-016685E207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAC28555Medicare UPIN