Individual
DR. RICHARD D. DIBACCO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
4402 PEACH ST, ERIE, PA 16509-1358
(814) 864-4874
(814) 864-4877
Mailing address
4402 PEACH ST, ERIE, PA 16509-1358
(814) 864-4874
(814) 864-4877
Taxonomy
Speciality
Code
Description
License number
State
213EP1101X
Primary Podiatric Medicine Podiatrist
SC001282L
PA
213ER0200X
Radiology Podiatrist
SC001282L
PA
213ES0103X
Foot & Ankle Surgery Podiatrist
SC001282L
PA
213ES0131X
Foot Surgery Podiatrist
Primary
SC001282L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000501005-0001
—
PA
Enumeration date
02/08/2006
Last updated
06/30/2010
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