Provider Demographics
NPI:1578434544
Name:DIGIACOMO, GRACE (PA-C)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:DIGIACOMO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 MEADOW ST
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-1202
Mailing Address - Country:US
Mailing Address - Phone:814-573-4678
Mailing Address - Fax:
Practice Address - Street 1:4247 W RIDGE RD STE 105
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16506-1746
Practice Address - Country:US
Practice Address - Phone:814-838-2468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-15
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA007420207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine