1386692002 NPI number — DORIA A SCORTICHINI M.D., F.A.C.C.

Table of content: DORIA A SCORTICHINI M.D., F.A.C.C. (NPI 1386692002)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386692002 NPI number — DORIA A SCORTICHINI M.D., F.A.C.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCORTICHINI
Provider First Name:
DORIA
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D., F.A.C.C.
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:
1386692002
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/15/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1150 STATE ROUTE 5 AND 20
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GENEVA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14456-9543
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-789-5758
Provider Business Mailing Address Fax Number:
315-789-0741

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1150 STATE ROUTE 5 AND 20
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GENEVA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14456-9543
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-789-5758
Provider Business Practice Location Address Fax Number:
315-789-0741
Provider Enumeration Date:
05/05/2006

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: 207RC0000X , with the licence number:  154650 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00020507201 . This is a "UNIVERA ID#" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00868566 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2197940 . This is a "GHI PROVIDER ID#" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000911281001 . This is a "HEALTHNOW PROVIDER ID#" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P010154650 . This is a "BLUE CHOICE PROVIDER ID#" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P010154650 . This is a "EXCELLUS BLUE SHIELD ID#" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: RC60154650 . This is a "DOCTORS' HEALTH PLAN ID#" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 102435BO . This is a "PREFERRED CARE ID#" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2178111 . This is a "FIRST HEALTH ID#" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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