Healthcare Provider Details

I. General information

NPI: 1467944587
Provider Name (Legal Business Name): MICHAEL ANGELO COSCIA III DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2018
Last Update Date: 01/24/2025
Certification Date: 01/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 NORTH ACADEMY AVE
DANVILLE PA
17822-9800
US

IV. Provider business mailing address

100 N ACADEMY AVE
DANVILLE PA
17822-9800
US

V. Phone/Fax

Practice location:
  • Phone: 570-271-7149
  • Fax: 570-271-7165
Mailing address:
  • Phone: 570-271-7149
  • Fax: 570-271-7165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberOS022907
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: