Provider Demographics
NPI:1992917959
Name:DISCEPOLA, CONSTANTINA (MD)
Entity type:Individual
Prefix:DR
First Name:CONSTANTINA
Middle Name:
Last Name:DISCEPOLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1466 HIPPOCRATES WAY
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-3400
Mailing Address - Country:US
Mailing Address - Phone:914-909-2546
Mailing Address - Fax:888-493-3369
Practice Address - Street 1:1466 HIPPOCRATES WAY
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-3400
Practice Address - Country:US
Practice Address - Phone:914-909-2546
Practice Address - Fax:888-493-3369
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME122085208D00000X
NY192494208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5410V1Medicare PIN