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Individual

DEAN M. CLERICO

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
190 WELLES ST, FORTY FORT, PA 18704-4968
(570) 283-0524
(570) 283-0302
Mailing address
190 WELLES ST, FORTY FORT, PA 18704-4968
(570) 283-0524
(570) 283-0302

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MD047846L
PA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0013050350002
PA
Enumeration date
06/30/2006
Last updated
07/08/2007
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