Basic Information
| Provider Information | |||||||||
| NPI: | 1518585553 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TRICOU | ||||||||
| FirstName: | ERIC | ||||||||
| MiddleName: | PAUL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 N ACADEMY AVE # MC26-02 | ||||||||
| Address2: | |||||||||
| City: | DANVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 178229800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5702142637 | ||||||||
| FaxNumber: | 5702147342 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 SCENERY DR | ||||||||
| Address2: | |||||||||
| City: | STATE COLLEGE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 168017974 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8002304565 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2020 | ||||||||
| LastUpdateDate: | 01/18/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 170300000X | Y | Other Service Providers | Genetic Counselor, MS |
No ID Information.