MEDICARE: WHITE OAK WELLNESS

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	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1124658331
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WHITE OAK WELLNESS

Provider Business Mailing Address
First Line	:	1966 LINCOLN WAY STE 100
Second Line	:
City	:	WHITE OAK
State	:	PA
Zip	:	15131-2416
Country	:	US
Telephone Number	:	412-673-5653
Fax Number	:	412-673-5848

Provider Business Practice Location Address
First Line	:	1966 LINCOLN WAY STE 100
Second Line	:
City	:	WHITE OAK
State	:	PA
Zip	:	15131-2416
Country	:	US
Telephone Number	:	412-673-5653
Fax Number	:	412-673-5848

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. ROCCO ANTON FULCINITI
Credential	:	MD
Telephone Number	:	412-673-5653

Provider Enumeration Date	:	01/16/2020
Last Update Date	:	01/16/2020

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Directions to “WHITE OAK WELLNESS ” Practice Location

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