Provider Demographics
NPI:1598720609
Name:TRICARICO, LISA CATHERINE (DO)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:CATHERINE
Last Name:TRICARICO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:457 NORTH MAIN ST
Mailing Address - Street 2:STE 105
Mailing Address - City:PITTSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18640-2185
Mailing Address - Country:US
Mailing Address - Phone:570-883-9444
Mailing Address - Fax:570-883-9333
Practice Address - Street 1:457 NORTH MAIN ST
Practice Address - Street 2:STE 105
Practice Address - City:PITTSTON
Practice Address - State:PA
Practice Address - Zip Code:18640-2185
Practice Address - Country:US
Practice Address - Phone:570-883-9444
Practice Address - Fax:570-883-9333
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-20
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOS010595L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA050615OtherMEDICARE ID - 050615
PA65252 E187OtherGEISINGER GOLD
PW340964OtherPHS
PA0018711180001Medicaid
PA002588OtherAETNA
PA002626OtherFIRST PRIORITY HEALTH CAP
2342215000OtherBS PERSONAL CHOICE
PA65252 E187OtherGEISINGER HEALTH
PAH47131OtherSTERLING
PA1310719OtherFIRST PRIORITY LIFE
H47131Medicare UPIN