Individual
DOMINIC DERENGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
4417 N 6TH ST, PHILADELPHIA, PA 19140-2319
(215) 302-6000
Mailing address
4417 N 6TH ST, PHILADELPHIA, PA 19140-2319
(215) 302-3600
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
OS019248
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1034592020002
—
PA
05
—
1034592020003
—
PA
05
—
1034592020004
—
PA
Enumeration date
05/20/2015
Last updated
10/10/2018
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