Individual
BRYAN CICUTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1535 HIGHLANDS DR STE 300, LITITZ, PA 17543-7681
(717) 625-3509
(717) 625-4258
Mailing address
409 S 2ND ST STE 2F, HARRISBURG, PA 17104-1612
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
OT010894
PA
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
OS017124
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1029496100006
—
PA
Enumeration date
05/15/2007
Last updated
10/02/2019
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