Provider Demographics
NPI:1144216524
Name:PACELLI, JAMES P JR (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:P
Last Name:PACELLI
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:100 HOSPITAL AVE
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-1440
Mailing Address - Country:US
Mailing Address - Phone:814-375-6560
Mailing Address - Fax:814-372-2848
Practice Address - Street 1:145 HOSPITAL AVE STE 211
Practice Address - Street 2:
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-1464
Practice Address - Country:US
Practice Address - Phone:814-375-2070
Practice Address - Fax:814-375-2076
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4248122084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1018604490001Medicaid
PA1018604490001Medicaid
PA7454654OtherAETNA NON-HMO
PA1466519OtherAETNA HMO
PAI32014OtherHEALTH AMERICA
PA1544641OtherGATEWAY HEALTH PLAN
PA1739253OtherHIGHMARK BLUE SHIELD
PA50065490OtherCAPITAL BLUE CROSS
PA1466519OtherAETNA HMO
PA1018604490001Medicaid