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General NPI Number Information
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NPI Number | 1144487406
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Entity Type | Organization
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Legal Business Name | CICERON L. OPIDA MD
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Dates
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Enumeration Date | 05/22/2008
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Last Update Date | 05/22/2008
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Provider Practice Location Address
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Address Line | 1915 VALLEY VIEW BLVD
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City | ALTOONA
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State | PA
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Zip | 16602-6527
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Country | US
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Telephone | 814-946-5000
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Fax | 814-946-9058
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Provider Business Mailing Address
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Address Line | 1915 VALLEY VIEW BLVD
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City | ALTOONA
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State | PA
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Zip | 16602-6527
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Country | US
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Telephone | 814-946-5000
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Fax | 814-946-9058
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Authorized Official
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Title or Position | OWNER
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Name | DR. CICERON L OPIDA
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Credential | MD
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Telephone | 814-946-5000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number | MD020883E
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License Number State | PA
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