Provider Demographics
NPI:1225083058
Name:LICATA, GAETANO JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:GAETANO
Middle Name:JOSEPH
Last Name:LICATA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9226 WILLOUGHBY RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15237-4522
Mailing Address - Country:US
Mailing Address - Phone:412-367-3945
Mailing Address - Fax:
Practice Address - Street 1:720 BLACKBURN RD
Practice Address - Street 2:
Practice Address - City:SEWICKLEY
Practice Address - State:PA
Practice Address - Zip Code:15143-1459
Practice Address - Country:US
Practice Address - Phone:412-749-7076
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD421210207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAH94509Medicare UPIN