Provider Demographics
NPI:1902061096
Name:DILIBERO, STEVEN (RO)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:DILIBERO
Suffix:
Gender:M
Credentials:RO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 MINERAL SPRING AVE
Mailing Address - Street 2:
Mailing Address - City:N PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-3742
Mailing Address - Country:US
Mailing Address - Phone:401-353-9020
Mailing Address - Fax:
Practice Address - Street 1:1920 MINERAL SPRING AVE
Practice Address - Street 2:
Practice Address - City:N PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-3742
Practice Address - Country:US
Practice Address - Phone:401-353-9020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-28
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRI122332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIRI0122OtherEYE MED
RI4219-2857OtherNEIGHBORHOOD HEALTH
RI21-09020OtherUNITED HEALTH CARE
RI9007933Medicaid