Basic Information
| Provider Information | |||||||||
| NPI: | 1013966548 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | URQUICO | ||||||||
| FirstName: | CECILIA | ||||||||
| MiddleName: | T. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 644850 | ||||||||
| Address2: | |||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152644850 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4129378887 | ||||||||
| FaxNumber: | 4129379221 | ||||||||
| Practice Location | |||||||||
| Address1: | 2501 W 12TH ST | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | ERIE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 165054527 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8148061144 | ||||||||
| FaxNumber: | 8148330659 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2006 | ||||||||
| LastUpdateDate: | 12/21/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD435122 | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | P01058226 | 01 | PA | RR MEDICARE | OTHER | 002060951 | 01 | PA | HIGHMARK BCBS | OTHER | 1026730840001 | 05 | PA | MEDICAID |