Provider Demographics
NPI:1275781569
Name:RICOTTA, CARA M (DO)
Entity Type:Individual
Prefix:
First Name:CARA
Middle Name:M
Last Name:RICOTTA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:CARA
Other - Middle Name:M
Other - Last Name:DELLEGROTTI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:2520 GREEN TECH DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16803-2300
Mailing Address - Country:US
Mailing Address - Phone:814-278-4898
Mailing Address - Fax:814-231-2004
Practice Address - Street 1:2520 GREEN TECH DR
Practice Address - Street 2:SUITE C
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16803-2300
Practice Address - Country:US
Practice Address - Phone:814-278-4898
Practice Address - Fax:814-231-2004
Is Sole Proprietor?:No
Enumeration Date:2008-08-29
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS015650207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1026176570001Medicaid
PA1434084P01OtherCIGNA
PA150199OtherGEISINGER
PA002461860OtherHIGHMARK BC/BS