Individual
ELAINE MARGUERITE DIMICCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2 MI NORTH OF WHITEDEER, WHITEDEER, PA 17717
(570) 547-0963
Mailing address
2 LIBERTY ST, WATSONTOWN, PA 17777-1315
(908) 303-3566
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
MA054675
PA
Other
Enumeration date
07/30/2009
Last updated
11/04/2014
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