Provider Demographics
NPI:1073587580
Name:PROCACCI, PASQUALE M (MD)
Entity Type:Individual
Prefix:
First Name:PASQUALE
Middle Name:M
Last Name:PROCACCI
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Gender:M
Credentials:MD
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Mailing Address - Street 1:207 N BROAD ST
Mailing Address - Street 2:3RD FLR.
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-1500
Mailing Address - Country:US
Mailing Address - Phone:215-462-7100
Mailing Address - Fax:215-463-3820
Practice Address - Street 1:1703 S BROAD ST
Practice Address - Street 2:SUITE 300
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19148-1536
Practice Address - Country:US
Practice Address - Phone:215-463-5333
Practice Address - Fax:215-463-8085
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2013-01-25
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Provider Licenses
StateLicense IDTaxonomies
PAMD012227E207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000721564Medicaid
PA000721564Medicaid