Provider Demographics
NPI:1548350879
Name:DIMARCO, ANTHONY E (DO)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:E
Last Name:DIMARCO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1020 BALTIMORE PIKE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GLEN MILLS
Mailing Address - State:PA
Mailing Address - Zip Code:19342
Mailing Address - Country:US
Mailing Address - Phone:484-227-7790
Mailing Address - Fax:484-227-7791
Practice Address - Street 1:1020 BALTIMORE PIKE STE 100
Practice Address - Street 2:
Practice Address - City:GLEN MILLS
Practice Address - State:PA
Practice Address - Zip Code:19342-1365
Practice Address - Country:US
Practice Address - Phone:484-227-7790
Practice Address - Fax:484-227-7791
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2017-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS006595L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAE22004Medicare UPIN
PA520649Medicare ID - Type Unspecified
PA001216919Medicaid