Provider Demographics
NPI:1073154456
Name:DAMICO, CHRISTINA (PA)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:DAMICO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:120 LYTTON AVE STE M059
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213-1481
Mailing Address - Country:US
Mailing Address - Phone:412-623-8905
Mailing Address - Fax:412-623-8906
Practice Address - Street 1:120 LYTTON AVE STE M059
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-1481
Practice Address - Country:US
Practice Address - Phone:412-623-8905
Practice Address - Fax:412-623-8906
Is Sole Proprietor?:No
Enumeration Date:2019-10-07
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMA061127363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant