Healthcare Provider Details

I. General information

NPI: 1457314833
Provider Name (Legal Business Name): RADU I PACURARIU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 WYOMING AVE STE # 201
FORTY FORT PA
18704-3953
US

IV. Provider business mailing address

920 WYOMING AVE STE # 201
FORTY FORT PA
18704-3953
US

V. Phone/Fax

Practice location:
  • Phone: 570-288-6115
  • Fax: 570-288-4941
Mailing address:
  • Phone: 570-288-6115
  • Fax: 570-288-4941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD035657L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: