Healthcare Provider Details

I. General information

NPI: 1700913456
Provider Name (Legal Business Name): MARK R. LODICO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 08/24/2022
Certification Date: 08/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 STONEWOOD DR SUITE 151
WEXFORD PA
15090-7376
US

IV. Provider business mailing address

7000 STONEWOOD DR STE. 151
WEXFORD PA
15090
US

V. Phone/Fax

Practice location:
  • Phone: 724-933-0300
  • Fax:
Mailing address:
  • Phone: 724-933-0300
  • Fax: 724-933-0456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD047135L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberMD047135L
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number27284
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: