Healthcare Provider Details

I. General information

NPI: 1578190153
Provider Name (Legal Business Name): MARTIN CICHON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2020
Last Update Date: 03/10/2026
Certification Date: 03/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 GLASSWORKS RD
GREENSBORO PA
15338-9507
US

IV. Provider business mailing address

331 TRINITY DR
WASHINGTON PA
15301-5723
US

V. Phone/Fax

Practice location:
  • Phone: 724-943-3308
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD481813
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: