MEDICARE: DR. JOSEPH THOMAS D AMICO CRNA

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	367500000X	Certified Registered Nurse Anesthetist	RN281110L	PA

General Provider Information

NPI Number	:	1295739118
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH THOMAS D AMICO CRNA

Provider Business Mailing Address
First Line	:	3639 E VIEW DR
Second Line	:
City	:	OREFIELD
State	:	PA
Zip	:	18069-2034
Country	:	US
Telephone Number	:	610-428-1544
Fax Number	:

Provider Business Practice Location Address
First Line	:	3639 E VIEW DR
Second Line	:
City	:	OREFIELD
State	:	PA
Zip	:	18069-2034
Country	:	US
Telephone Number	:	610-428-1544
Fax Number	:

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

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	07/08/2007

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