Basic Information
| Provider Information | |||||||||
| NPI: | 1386621688 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DICAMILLO | ||||||||
| FirstName: | VITO | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2118 SPRING VALLEY RD | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 176012427 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7175440150 | ||||||||
| FaxNumber: | 7175440151 | ||||||||
| Practice Location | |||||||||
| Address1: | 2118 SPRING VALLEY RD | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 176012427 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7175440150 | ||||||||
| FaxNumber: | 7175440151 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/28/2005 | ||||||||
| LastUpdateDate: | 06/30/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/30/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | MD066259L | PA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 001731304 | 05 | PA | MEDICAID |