Individual
JACOB A DICESARE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
438 PELLIS RD, GREENSBURG, PA 15601-7900
(724) 261-4080
(724) 261-4081
Mailing address
PO BOX 7, BOVARD, PA 15619-0007
(724) 261-4080
(724) 261-4081
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
OS014434
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102533207 0001
—
PA
Enumeration date
01/24/2009
Last updated
09/08/2020
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