Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | MD006114E | PA |
NPI | 1174658793 |
---|---|
Provider Name | Dr. Alphonse Joseph Digiovanni |
First Address | Newtown Square, PA 19073-2782 |
Second Address | Philadelphia, PA 19153-2300 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2007 |
Last Update Date | 08/07/2007 |