Healthcare Provider Details

I. General information

NPI: 1891767653
Provider Name (Legal Business Name): BRIAN CICUTO DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 12/01/2020
Certification Date: 12/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1709 UNION AVE
NATRONA HEIGHTS PA
15065-2104
US

IV. Provider business mailing address

1709 UNION AVE
NATRONA HEIGHTS PA
15065-2104
US

V. Phone/Fax

Practice location:
  • Phone: 724-226-0080
  • Fax: 724-226-0083
Mailing address:
  • Phone: 724-226-0080
  • Fax: 724-226-0083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberOS007460L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: