MEDICARE: FIORELLI UROLOGY ASSOCIATES, PC

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	208800000X	Urology Physician	OS005553L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2004118	OTHER	PA	HIGHMARK BLUE SHIELD
2	769M	OTHER	PA	GEISINGER HEALTH PLAN
3	2004118	OTHER	PA	FIRST PRIORITY LIFE
4	4399736	OTHER	PA	AETNA

General Provider Information

NPI Number	:	1851577324
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIORELLI UROLOGY ASSOCIATES, PC

Provider Business Mailing Address
First Line	:	1155 RTE. 315
Second Line	:
City	:	WILKES-BARRE
State	:	PA
Zip	:	18702-6928
Country	:	US
Telephone Number	:	570-820-3320
Fax Number	:	570-820-3388

Provider Business Practice Location Address
First Line	:	1155 RTE. 315
Second Line	:
City	:	WILKES-BARRE
State	:	PA
Zip	:	18702-6928
Country	:	US
Telephone Number	:	570-820-3320
Fax Number	:	570-820-3388

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ROBERT LOUIS FIORELLI
Credential	:	D.O.
Telephone Number	:	570-820-3320

Provider Enumeration Date	:	01/15/2008
Last Update Date	:	05/02/2008

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