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NPI Code Detail

MEDICARE: MR. MICHAEL J BACCOLI MD

MEDICARE: MR. MICHAEL J BACCOLI MD
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
12084N0400XNeurology PhysicianMD062157LPA

General Provider Information

NPI Number : 1437118411
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MICHAEL J BACCOLI MD
Provider Business Mailing Address
First Line : 802 JEFFERSON AVENUE
Second Line :
City : SCRANTON
State : PA
Zip : 18510
Country : US
Telephone Number : 570-348-1118
Fax Number : 570-348-1109
Provider Business Practice Location Address
First Line : 802 JEFFERSON AVE
Second Line :
City : SCRANTON
State : PA
Zip : 18510-1038
Country : US
Telephone Number : 570-348-1118
Fax Number : 570-348-1118
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/20/2006
Last Update Date : 03/10/2021

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