Organization
PORTLAND MEDICAL CENTER, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RAYMOND DECESARE D.O. (PRESIDENT)
(570) 897-6272
Entity
Organization
Contact information
Practice address
716 DELAWARE AVENUE, PORTLAND, PA 18351-0358
(570) 897-6272
Mailing address
716 DELAWARE AVENUE, PORTLAND, PA 18351-0358
(570) 897-6272
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
OS002690L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001706
FIRST PRIORITY
PA
01
—
14843
GEISENGERS HEALTH CARE
—
01
—
548961
US HEALTHCARE
—
01
—
DE 041920
PA BLUE SHIELD
—
Enumeration date
04/03/2007
Last updated
08/22/2020
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