Individual
DOMENIC PISANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
196 W SPROUL RD, SUITE 106, SPRINGFIELD, PA 19064-2045
(610) 543-4000
(610) 543-4003
Mailing address
207 N BROAD ST, 3RD FLR., PHILADELPHIA, PA 19107-1500
(215) 462-7100
(215) 463-3820
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
OS002998L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000751895
—
PA
Enumeration date
02/14/2006
Last updated
08/15/2011
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