Individual
MARK J MICCICHE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
1800 MULBERRY ST, SCRANTON, PA 18510-2369
(570) 703-8146
(570) 703-7205
Mailing address
100 N ACADEMY AVE, DANVILLE, PA 17822-4903
(570) 271-6144
(570) 271-6578
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
SC-003638-L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0015256920005
—
PA
Enumeration date
05/25/2006
Last updated
08/21/2020
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