Provider Demographics
NPI:1295739118
Name:D AMICO, JOSEPH THOMAS (CRNA)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:THOMAS
Last Name:D AMICO
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3639 E VIEW DR
Mailing Address - Street 2:
Mailing Address - City:OREFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:18069-2034
Mailing Address - Country:US
Mailing Address - Phone:610-428-1544
Mailing Address - Fax:
Practice Address - Street 1:3639 E VIEW DR
Practice Address - Street 2:
Practice Address - City:OREFIELD
Practice Address - State:PA
Practice Address - Zip Code:18069-2034
Practice Address - Country:US
Practice Address - Phone:610-428-1544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN281110L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA005440Medicare ID - Type Unspecified