Healthcare Provider Details

I. General information

NPI: 1982675401
Provider Name (Legal Business Name): ROBERT J. CONCINI PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 06/20/2025
Certification Date: 06/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 PENN AVE
SCRANTON PA
18503-1921
US

IV. Provider business mailing address

4100 BEAR CREEK BLVD
BEAR CREEK TOWNSHIP PA
18702-9717
US

V. Phone/Fax

Practice location:
  • Phone: 570-342-7864
  • Fax: 570-342-7119
Mailing address:
  • Phone: 570-709-7048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number0110005909
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberMA051003
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA051003
License Number StatePA

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: