Healthcare Provider Details

I. General information

NPI: 1821232265
Provider Name (Legal Business Name): JOSEPH GIACOMETTI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2009
Last Update Date: 12/01/2022
Certification Date: 12/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MIFFLIN AVE
SCRANTON PA
18503-1982
US

IV. Provider business mailing address

200 MIFFLIN AVE
SCRANTON PA
18503-1982
US

V. Phone/Fax

Practice location:
  • Phone: 570-342-3145
  • Fax: 610-687-8773
Mailing address:
  • Phone: 570-342-3145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number25MA09527400
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD451265
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberP2993
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code207WX0200X
TaxonomyOphthalmic Plastic and Reconstructive Surgery Physician
License Number25MA09527400
License Number StateNJ
# 5
Primary TaxonomyY
Taxonomy Code207WX0200X
TaxonomyOphthalmic Plastic and Reconstructive Surgery Physician
License NumberMD451265
License Number StatePA

VII. Legacy identifiers

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

# 1
Identifier122537
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerMEDICARE PTAN
# 2
Identifier102977689
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer
# 3
Identifier102973
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerMEDICARE PTAN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: