MEDICARE: STEPHEN JOSEPH DELCASINO JR. 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	PA1417	ME

General Provider Information

NPI Number	:	1972944494
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN JOSEPH DELCASINO JR. PA-C

Provider Business Mailing Address
First Line	:	43 WHITING HILL RD
Second Line	:	CIANCHETTE BUILDING
City	:	BREWER
State	:	ME
Zip	:	04412-1005
Country	:	US
Telephone Number	:	207-973-5233
Fax Number	:

Provider Business Practice Location Address
First Line	:	7500 SMOKE RANCH RD STE 200
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-0373
Country	:	US
Telephone Number	:	702-233-0727
Fax Number	:	702-233-4799

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

Provider Enumeration Date	:	07/12/2013
Last Update Date	:	09/28/2020

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