Provider Demographics
NPI:1023005378
Name:OLIVO, DOMINICK (DPM)
Entity type:Individual
Prefix:DR
First Name:DOMINICK
Middle Name:
Last Name:OLIVO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4903
Mailing Address - Country:US
Mailing Address - Phone:570-308-2564
Mailing Address - Fax:570-308-2566
Practice Address - Street 1:255 ROUTE 220 HWY STE 205
Practice Address - Street 2:
Practice Address - City:MUNCY
Practice Address - State:PA
Practice Address - Zip Code:17756-7568
Practice Address - Country:US
Practice Address - Phone:570-308-2564
Practice Address - Fax:570-308-2566
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC007536213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0000390660Medicaid
MT00083088Medicare ID - Type Unspecified
MT0000390660Medicaid