MEDICARE: RANDI MONTAGNA SACCO PA-C

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	363A00000X	Physician Assistant	MA057226	PA

General Provider Information

NPI Number	:	1306249883
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RANDI MONTAGNA SACCO PA-C

Provider Business Mailing Address
First Line	:	2500 W 12TH ST
Second Line	:
City	:	ERIE
State	:	PA
Zip	:	16505-4500
Country	:	US
Telephone Number	:	814-838-9000
Fax Number	:

Provider Business Practice Location Address
First Line	:	2500 W 12TH ST
Second Line	:
City	:	ERIE
State	:	PA
Zip	:	16505-4500
Country	:	US
Telephone Number	:	814-838-9000
Fax Number	:

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

Provider Enumeration Date	:	09/29/2014
Last Update Date	:	12/05/2025

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Directions to “ RANDI MONTAGNA SACCO PA-C” Practice Location

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