Healthcare Provider Details

I. General information

NPI: 1346369279
Provider Name (Legal Business Name): HAZLETON CHILDREN'S MEDICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1730 E BROAD ST SUITE 2
HAZLETON PA
18201-5622
US

IV. Provider business mailing address

1730 E BROAD ST SUITE 2
HAZLETON PA
18201-5622
US

V. Phone/Fax

Practice location:
  • Phone: 570-455-7823
  • Fax: 570-455-8848
Mailing address:
  • Phone: 570-455-7823
  • Fax: 570-455-8848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

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

# 1
Identifier0015718460001
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: JAMES F. CAGGIANO
Title or Position: VICE PRESIDENT
Credential: M.D.
Phone: 570-455-7823