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General NPI Number Information
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NPI Number | 1558366971
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Entity Type | Individual
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Provider Name | GARY E PASQUALICCHIO DO
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Gender | Male
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Dates
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Enumeration Date | 06/14/2005
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Last Update Date | 01/27/2023
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Provider Practice Location Address
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Address Line | 991 PARK AVE
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City | MEADVILLE
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State | PA
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Zip | 16335-3344
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Country | US
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Telephone | 814-373-4298
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Fax | 814-724-2196
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Provider Business Mailing Address
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Address Line | 1034 GROVE ST
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City | MEADVILLE
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State | PA
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Zip | 16335-2945
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Country | US
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Telephone | 814-373-4296
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Fax | 814-724-2196
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OS003597L
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | OS003597L
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License Number State | PA
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