=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508016510
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RICHELE ANN PICA PA-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/25/2008
-----------------------------------------------------
Last Update Date | 04/06/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 240 CETRONIA ROARD SUITE 200N
-----------------------------------------------------
City | ALLENTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18104-9263
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 484-426-2600
-----------------------------------------------------
Fax | 833-816-7512
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 323 WOLF DR
-----------------------------------------------------
City | ALLENTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18104-9517
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-498-6713
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------