Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | MD457532 | PA |
N | 111NI0900X | Internist | MD457532 | PA |
Y | 207RC0200X | Critical Care Medicine | MD457532 | PA |
N | 207RP1001X | Pulmonary Disease | MD457532 | PA |
NPI | 1003127135 |
---|---|
Provider Name | Dr. David Michael Dibardino |
First Address | Philadelphia, PA 19104-5161 |
Second Address | Philadelphia, PA 19104-5161 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2010 |
Last Update Date | 12/09/2019 |