Healthcare Provider Details

I. General information

NPI: 1689639676
Provider Name (Legal Business Name): ROBERT A CICUTO DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 03/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2213 SHENANGO VALLEY FREEWAY
HERMITAGE PA
16148
US

IV. Provider business mailing address

2213 SHENANGO VALLEY FREEWAY
HERMITAGE PA
16148
US

V. Phone/Fax

Practice location:
  • Phone: 724-346-1234
  • Fax: 724-346-4033
Mailing address:
  • Phone: 724-346-1234
  • Fax: 724-346-4033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS002959L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: