Provider Demographics
NPI:1467425074
Name:SCICUTELLA, CAROL J (DO)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:J
Last Name:SCICUTELLA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 CORAOPOLIS HEIGHTS RD
Mailing Address - Street 2:DEPT OF RADIATION ONCOLOGY
Mailing Address - City:MOON TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:15108-4316
Mailing Address - Country:US
Mailing Address - Phone:412-604-2020
Mailing Address - Fax:412-604-2046
Practice Address - Street 1:1600 CORAOPOLIS HEIGHTS RD
Practice Address - Street 2:DEPT OF RADIATION ONCOLOGY
Practice Address - City:MOON TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:15108-4316
Practice Address - Country:US
Practice Address - Phone:412-604-2020
Practice Address - Fax:412-604-2046
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS006474E2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001183068Medicaid
PA427866Medicare ID - Type Unspecified
PA001183068Medicaid