Provider Demographics
NPI:1528179553
Name:PEDICINO, ALEXANDER R (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:R
Last Name:PEDICINO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1648 HUNTINGDON PIKE
Mailing Address - Street 2:MEDICAL STAFF OFFICE 1ST FLR
Mailing Address - City:MEADOWBROOK
Mailing Address - State:PA
Mailing Address - Zip Code:19046-8001
Mailing Address - Country:US
Mailing Address - Phone:215-938-3450
Mailing Address - Fax:215-938-3829
Practice Address - Street 1:1650 HUNTINGDON PIKE STE 315
Practice Address - Street 2:
Practice Address - City:MEADOWBROOK
Practice Address - State:PA
Practice Address - Zip Code:19046-8007
Practice Address - Country:US
Practice Address - Phone:215-947-8170
Practice Address - Fax:215-947-8572
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD017974E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1025836OtherKEYSTONE MERCY
PA0047066001OtherKEYSTONE HPE
PAB38545Medicare UPIN
PA0047066001OtherKEYSTONE HPE
PA1025836OtherKEYSTONE MERCY