1528029006 NPI number — DR. JAMES ANDREW TRICARICO DO

Table of content: DR. JAMES ANDREW TRICARICO DO (NPI 1528029006)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528029006 NPI number — DR. JAMES ANDREW TRICARICO DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TRICARICO
Provider First Name:
JAMES
Provider Middle Name:
ANDREW
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
M

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:
1528029006
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/12/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
457 NORTH MAIN ST
Provider Second Line Business Mailing Address:
STE 105
Provider Business Mailing Address City Name:
PITTSTON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18640-2185
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-883-9444
Provider Business Mailing Address Fax Number:
570-883-9333

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
499 WYOMING AVE STE 105
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KINGSTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18704-3602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-714-3050
Provider Business Practice Location Address Fax Number:
570-714-3055
Provider Enumeration Date:
04/01/2006

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:  OS010594L , 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: 002573 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 60253 E180 . This is a "GEISINGER HEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 001863297001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1307341 . This is a "FIRST PRIORITY LIFE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 002627 . This is a "FIRST PRIORITY HEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 60253 E180 . This is a "GEISINGER GOLD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 002627 . This is a "FIRST PRIORITY HEALTH CAP" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 080176555 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 60253 . This is a "GEISINGER CAPITATION" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 002573 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 047917 . This is a "MEDICARE-MLRM" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1307341 . This is a "PA BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 010122600 . This is a "FEDERAL BLACK LUNG" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2000683000 . This is a "PA BS PERSONAL CHOICE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 249865 . This is a "PHS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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