Provider Demographics
NPI:1801852884
Name:D'AMICO, CARMINE DANIEL (DO)
Entity Type:Individual
Prefix:
First Name:CARMINE
Middle Name:DANIEL
Last Name:D'AMICO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 LECOM PL
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16505-2571
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:814-868-2522
Practice Address - Street 1:5401 PEACH ST STE 3600
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16509-2601
Practice Address - Country:US
Practice Address - Phone:814-868-2170
Practice Address - Fax:814-868-2108
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS006839L207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011702660014Medicaid
PA591421Medicare PIN
PA1170266Medicaid
PADA955194OtherBLUE SHIELD