Healthcare Provider Details

I. General information

NPI: 1356703193
Provider Name (Legal Business Name): PHILIP TALARICO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2016
Last Update Date: 02/14/2025
Certification Date: 02/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18201 CONNEAUT LAKE RD
MEADVILLE PA
16335-3757
US

IV. Provider business mailing address

1034 GROVE ST
MEADVILLE PA
16335-2945
US

V. Phone/Fax

Practice location:
  • Phone: 814-333-5060
  • Fax: 814-333-5067
Mailing address:
  • Phone: 814-333-5060
  • Fax: 814-333-5067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberOS020667
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: