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NPI Code Detail

MEDICARE: GARY E PASQUALICCHIO DO

MEDICARE: GARY E PASQUALICCHIO DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianOS003597LPA
2207RG0300XGeriatric Medicine (Internal Medicine) PhysicianOS003597LPA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10110211322OTHERPARR MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2P000010OTHERPAGATEWAY
30567211OTHEROHOH MEDICAL ASSISTANCE
4214426OTHERPAUPMC
5049521OTHERPABLUE SHIELD
6151367OTHERPAUNISON
7828383OTHERPAAETNA
800051085003OTHERNYUNIVERA
901267270OTHERNYNY MEDICAL ASSISTANCE

General Provider Information

NPI Number : 1558366971
Entity Type Code : Individual
Provider Name (Legal Business Name) : GARY E PASQUALICCHIO DO
Provider Business Mailing Address
First Line : 1034 GROVE ST
Second Line :
City : MEADVILLE
State : PA
Zip : 16335-2945
Country : US
Telephone Number : 814-373-4296
Fax Number : 814-724-2196
Provider Business Practice Location Address
First Line : 991 PARK AVE
Second Line :
City : MEADVILLE
State : PA
Zip : 16335-3344
Country : US
Telephone Number : 814-373-4298
Fax Number : 814-724-2196
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/14/2005
Last Update Date : 01/27/2023

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Directions to “ GARY E PASQUALICCHIO DO” Practice Location

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