Provider Demographics
NPI:1922181791
Name:PIDICH, REGINA M (NP)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:M
Last Name:PIDICH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:246 GRANDVIEW ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH ABINGTON TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:18411-8975
Mailing Address - Country:US
Mailing Address - Phone:570-586-9471
Mailing Address - Fax:
Practice Address - Street 1:246 GRANDVIEW ST
Practice Address - Street 2:
Practice Address - City:SOUTH ABINGTON TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:18411-8975
Practice Address - Country:US
Practice Address - Phone:570-586-9471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATP002122B207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
S85382Medicare UPIN