1013966548 NPI number — CECILIA T. URQUICO M.D.

Table of content: (NPI 1194240556)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013966548 NPI number — CECILIA T. URQUICO M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
URQUICO
Provider First Name:
CECILIA
Provider Middle Name:
T.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013966548
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/21/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 644850
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PITTSBURGH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15264-4850
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-937-8887
Provider Business Mailing Address Fax Number:
412-937-9221

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2501 W 12TH ST
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
ERIE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16505-4527
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-806-1144
Provider Business Practice Location Address Fax Number:
814-833-0659
Provider Enumeration Date:
05/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  MD435122 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P01058226 . This is a "RR MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 002060951 . This is a "HIGHMARK BCBS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1026730840001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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