Provider Demographics
NPI:1437200755
Name:OPIDA, CICERON L (MD)
Entity Type:Individual
Prefix:DR
First Name:CICERON
Middle Name:L
Last Name:OPIDA
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 1:514 E. PLEASANT VALLEY BLVD
Mailing Address - Street 2:SUITE #3
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602
Mailing Address - Country:US
Mailing Address - Phone:814-946-5000
Mailing Address - Fax:814-942-2796
Practice Address - Street 1:514 E PLEASANT VALLEY BLVD
Practice Address - Street 2:SUITE #3
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-5574
Practice Address - Country:US
Practice Address - Phone:814-946-5000
Practice Address - Fax:814-946-9058
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA020833E2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007516800002Medicaid
PA026452Medicare PIN
PA0007516800002Medicaid