Individual
GARY E PASQUALICCHIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
991 PARK AVE, MEADVILLE, PA 16335-3344
(814) 373-4298
(814) 724-2196
Mailing address
1034 GROVE ST, MEADVILLE, PA 16335-2945
(814) 373-4296
(814) 724-2196
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
OS003597L
PA
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
OS003597L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00051085003
UNIVERA
NY
01
—
01267270
NY MEDICAL ASSISTANCE
NY
01
—
049521
BLUE SHIELD
PA
01
—
0567211
OH MEDICAL ASSISTANCE
OH
05
—
1011024470003
—
PA
01
—
110211322
RR MEDICARE
PA
01
—
151367
UNISON
PA
01
—
214426
UPMC
PA
01
—
828383
AETNA
PA
01
—
P000010
GATEWAY
PA
Enumeration date
06/14/2005
Last updated
01/27/2023
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