Provider Demographics
NPI:1063444289
Name:PISCITELLI, THOMAS A (DO)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:A
Last Name:PISCITELLI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15800 OLD CASTLE RD
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-1757
Mailing Address - Country:US
Mailing Address - Phone:804-801-4207
Mailing Address - Fax:804-858-3300
Practice Address - Street 1:1060 RIVER RD
Practice Address - Street 2:
Practice Address - City:NORTH PRINCE GEORGE
Practice Address - State:VA
Practice Address - Zip Code:23860-1666
Practice Address - Country:US
Practice Address - Phone:804-504-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2017-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9800662207R00000X
NY192778207R00000X
VA0102203386207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H31198Medicare UPIN
MIPNDMedicaid
MIOE06364008Medicare ID - Type Unspecified