Provider Demographics
NPI:1306801030
Name:PALUMBO, DANTE M (DO)
Entity type:Individual
Prefix:DR
First Name:DANTE
Middle Name:M
Last Name:PALUMBO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 PIERCE ST
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704-5532
Mailing Address - Country:US
Mailing Address - Phone:570-288-3535
Mailing Address - Fax:
Practice Address - Street 1:390 PIERCE ST
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-5532
Practice Address - Country:US
Practice Address - Phone:570-288-3535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB10408400207X00000X
PAOS019269207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q60406Medicare UPIN
PA099016Medicare ID - Type Unspecified