Healthcare Provider Details

I. General information

NPI: 1578713830
Provider Name (Legal Business Name): ROBERT ANTHONY PICA JR. PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2008
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 CETRONIA RD
ALLENTOWN PA
18104-9569
US

IV. Provider business mailing address

801 OSTRUM ST
BETHLEHEM PA
18015-1000
US

V. Phone/Fax

Practice location:
  • Phone: 484-426-2501
  • Fax:
Mailing address:
  • Phone: 484-526-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA053648
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: