Provider Demographics
NPI:1982658050
Name:DERRICO, ANNE-MARIE (MD)
Entity Type:Individual
Prefix:
First Name:ANNE-MARIE
Middle Name:
Last Name:DERRICO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 N WATER ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-3374
Mailing Address - Country:US
Mailing Address - Phone:717-299-6371
Mailing Address - Fax:
Practice Address - Street 1:304 N WATER ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-3374
Practice Address - Country:US
Practice Address - Phone:717-299-6371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-21
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD417665207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001408780OtherHIGHMARK
PA001957203 0001Medicaid
PA20043244OtherMERCY
PA261327OtherHEALTHAMERICA
PAP004949OtherGATEWAY
PA50055951OtherKEYSTONE HEALTH PLAN CENTRAL
PAP00023026OtherRR MEDICARE
PA000000257383OtherUNISON
PA7147679OtherAETNA-NON HMO
PA1089231OtherAETNA-HMO
PA2096244000OtherINDEPENDENCE BLUE CROSS
PA50055951OtherCAPITAL BLUE CROSS
PA20043244OtherMERCY
PAH84708Medicare UPIN