Provider Demographics
NPI:1487778098
Name:DR. JOANNA M. DELEO, P.C.
Entity type:Organization
Organization Name:DR. JOANNA M. DELEO, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOANNA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:DELEO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:717-652-5552
Mailing Address - Street 1:4811 JONESTOWN RD
Mailing Address - Street 2:SUITE 126
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17109-1745
Mailing Address - Country:US
Mailing Address - Phone:717-652-5552
Mailing Address - Fax:717-671-1870
Practice Address - Street 1:4811 JONESTOWN RD
Practice Address - Street 2:SUITE 126
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17109-1745
Practice Address - Country:US
Practice Address - Phone:717-652-5552
Practice Address - Fax:717-671-1870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS007425L208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA120384Medicare PIN
PAF98402Medicare UPIN
PA0015286490003Medicare ID - Type UnspecifiedPROMISE ID JOANNA DELEO