Healthcare Provider Details

I. General information

NPI: 1144930363
Provider Name (Legal Business Name): NICHOLAS PAUL PUGLIELLI PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2022
Last Update Date: 11/29/2022
Certification Date: 11/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 KNOWLSON AVE
BEAVER FALLS PA
15010-1634
US

IV. Provider business mailing address

100 KNOWLSON AVE
BEAVER FALLS PA
15010-1634
US

V. Phone/Fax

Practice location:
  • Phone: 724-891-2100
  • Fax: 724-891-2734
Mailing address:
  • Phone: 724-891-2100
  • Fax: 724-589-2734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA064239
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: