MEDICARE: LUCYANN M SCIANDRA DO

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	207RI0200X	Infectious Disease Physician	OS008466L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	977654	OTHER	PA	FIRST PRIORITY LIFE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	93627	OTHER	PA	GEISINGER HEALTH PLAN
4	977654	OTHER	PA	HIGHMARK BLUE SHIELD
5	819951	OTHER	PA	FIRST PRIORITY HEALTH

General Provider Information

NPI Number	:	1326096884
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUCYANN M SCIANDRA DO

Provider Business Mailing Address
First Line	:	545 N RIVER ST
Second Line	:	SUITE 205
City	:	WILKES BARRE
State	:	PA
Zip	:	18702-2600
Country	:	US
Telephone Number	:	570-822-6036
Fax Number	:	570-829-1520

Provider Business Practice Location Address
First Line	:	545 N RIVER ST
Second Line	:	SUITE 205
City	:	WILKES BARRE
State	:	PA
Zip	:	18702-2600
Country	:	US
Telephone Number	:	570-822-6036
Fax Number	:	570-829-1520

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

Provider Enumeration Date	:	05/05/2006
Last Update Date	:	11/19/2010

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Directions to “ LUCYANN M SCIANDRA DO” Practice Location

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