MEDICARE: DR. THOMAS A PISCITELLI D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	9800662	NC
2	207R00000X	Internal Medicine Physician	192778	NY
3	207R00000X	Internal Medicine Physician	0102203386	VA

General Provider Information

NPI Number	:	1063444289
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS A PISCITELLI D.O.

Provider Business Mailing Address
First Line	:	15800 OLD CASTLE RD
Second Line	:
City	:	MIDLOTHIAN
State	:	VA
Zip	:	23112-1757
Country	:	US
Telephone Number	:	804-801-4207
Fax Number	:	804-858-3300

Provider Business Practice Location Address
First Line	:	1060 RIVER RD
Second Line	:
City	:	NORTH PRINCE GEORGE
State	:	VA
Zip	:	23860-1666
Country	:	US
Telephone Number	:	804-504-7200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	01/21/2025

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