Provider Demographics
NPI:1912994815
Name:SCIARUTO, DOMENICK P (MD)
Entity Type:Individual
Prefix:
First Name:DOMENICK
Middle Name:P
Last Name:SCIARUTO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:60 ROBERTS DR STE 313
Mailing Address - Street 2:
Mailing Address - City:NORTH ADAMS
Mailing Address - State:MA
Mailing Address - Zip Code:01247-3254
Mailing Address - Country:US
Mailing Address - Phone:413-398-5509
Mailing Address - Fax:
Practice Address - Street 1:30 LOCUST ST
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-2052
Practice Address - Country:US
Practice Address - Phone:413-582-2363
Practice Address - Fax:413-582-2914
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA74916207PE0004X
CT63938207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA04-3329195OtherNORTHEAST HEALTH DIRECT
MA04-3329195OtherGREAT-WEST HEALTH PLAN
MA04-3329195OtherPHCS
MAAA38230OtherHARVARD PILGRIM
MAJ13367OtherBCBSMA
MA27760OtherHEALTH NEW ENGLAND
MA04-3329195OtherCOMMONWEALTH IND (UNICARE
MD30706OtherBMC
MA04-3329195OtherCONSOLIDATED HEALTH PLAN
MA347669OtherTUFTS
MA074916OtherCONNECTICARE
MA6424873OtherCIGNA
MA04-3329195OtherNORTHEAST HEALTHCARE ALLI
MA347669OtherAETNA
MA04-3329195OtherPLAN VISTA
MA04-3329195OtherNORTH AMERICAN PREFERRED