Micciche, Mark J
Micciche, Mark J is an individual health care provider with primary practice located at 1800 Mulberry St , Scranton PA 18510-2369. He recently has only one registered license in Podiatric Medicine & Surgery Service Providers / Podiatrist, which is considered as his primary health care specialty. Micciche, Mark J can be contacted via phone (570) 703-8146.Contact Information
Primary practice address
1800 Mulberry St
Scranton PA 18510-2369
Phone: (570) 703-8146
Fax: (570) 703-7205
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Podiatric Medicine & Surgery Service Providers / Podiatrist | 213E00000X | SC-003638-L | Pennsylvania |
Profile Details
| NPI number | 1336195031 |
|---|---|
| LBN Legal business name | Micciche, Mark J |
| Credentials | Doctor of Podiatric Medicine (DPM) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | May 25th, 2006 |
| Last updated | Aug 21st, 2020 - about 4 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1336195031 | NPPES |
| Pennsylvania | MEDICAID | 0015256920005 |
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