Provider Demographics
NPI:1942290176
Name:SICO, ANTHONY L (DO)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:L
Last Name:SICO
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 1:835 HOSPITAL RD
Mailing Address - Street 2:PO BOX 788
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-0788
Mailing Address - Country:US
Mailing Address - Phone:724-357-7009
Mailing Address - Fax:724-357-7414
Practice Address - Street 1:835 HOSPITAL RD
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-0788
Practice Address - Country:US
Practice Address - Phone:724-357-7121
Practice Address - Fax:724-357-7479
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS008004L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0014414670003Medicaid
PA000142964OtherBLUE SHIELD
PA207486OtherUPMC
PA142964GU9Medicare ID - Type Unspecified
PA000142964OtherBLUE SHIELD