Healthcare Provider Details

I. General information

NPI: 1710941489
Provider Name (Legal Business Name): DAVID J CAUCCI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2006
Last Update Date: 06/16/2022
Certification Date: 06/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3202 LAKE ARIEL HWY
HONESDALE PA
18431-7602
US

IV. Provider business mailing address

3355 LAKE ARIEL HWY
HONESDALE PA
18431-1174
US

V. Phone/Fax

Practice location:
  • Phone: 570-647-0001
  • Fax: 570-647-0004
Mailing address:
  • Phone: 570-647-0001
  • Fax: 570-647-0004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD065307L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: