Provider Demographics
NPI:1780887448
Name:MICUCIO, AMANDA CATHERINE (DO)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:CATHERINE
Last Name:MICUCIO
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Gender:
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 191
Mailing Address - Street 2:
Mailing Address - City:ROCKLAND
Mailing Address - State:DE
Mailing Address - Zip Code:19732-0191
Mailing Address - Country:US
Mailing Address - Phone:302-651-5985
Mailing Address - Fax:302-651-4945
Practice Address - Street 1:833 CHESTNUT ST
Practice Address - Street 2:SUITE 300
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4405
Practice Address - Country:US
Practice Address - Phone:215-861-8800
Practice Address - Fax:215-861-8815
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-08
Last Update Date:2025-02-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAOS015161208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics