Healthcare Provider Details

I. General information

NPI: 1487642906
Provider Name (Legal Business Name): MICHAEL A. PICARIELLO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 02/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 ARRANDALE BLVD
EXTON PA
19341-2503
US

IV. Provider business mailing address

111 ARRANDALE BLVD
EXTON PA
19341-2503
US

V. Phone/Fax

Practice location:
  • Phone: 610-363-2532
  • Fax: 610-363-0210
Mailing address:
  • Phone: 610-363-2532
  • Fax: 610-363-0210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License NumberMD039764E
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0012509010007
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: