Provider Demographics
NPI:1821232265
Name:GIACOMETTI, JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:GIACOMETTI
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 1:200 MIFFLIN AVE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18503-1982
Mailing Address - Country:US
Mailing Address - Phone:570-342-3145
Mailing Address - Fax:
Practice Address - Street 1:200 MIFFLIN AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18503-1982
Practice Address - Country:US
Practice Address - Phone:570-342-3145
Practice Address - Fax:610-687-8773
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-29
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09527400207W00000X, 207WX0200X
PAMD451265207W00000X, 207WX0200X
TXP2993207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive Surgery
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ122537OtherMEDICARE PTAN
NJ102977689Medicaid
PA102973OtherMEDICARE PTAN
PA102973OtherMEDICARE PTAN
NJ122537OtherMEDICARE PTAN