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1710973870

NPI Code Detail

MEDICARE: MR. SAMUEL DAVID LICATA MD

MEDICARE: MR. SAMUEL DAVID LICATA MD

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
1	208600000X	Surgery Physician	MD048163L	PA
2	208600000X	Surgery Physician	35064482	OH
3	208600000X	Surgery Physician	18107	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710973870
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SAMUEL DAVID LICATA MD

Provider Business Mailing Address
First Line	:	380 SUMMIT AVE
Second Line	:	MSO PHYSICIAN BILLING
City	:	STEUBENVILLE
State	:	OH
Zip	:	43952-2667
Country	:	US
Telephone Number	:	740-283-7776
Fax Number	:	740-283-7807

Provider Business Practice Location Address
First Line	:	4000 JOHNSON RD
Second Line	:	2ND FLOOR
City	:	STEUBENVILLE
State	:	OH
Zip	:	43952-2364
Country	:	US
Telephone Number	:	740-266-5959
Fax Number	:	740-266-5957

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/23/2005
Last Update Date	:	12/11/2025

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Directions to “ MR. SAMUEL DAVID LICATA MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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