Basic Information
| Provider Information | |||||||||
| NPI: | 1598720609 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TRICARICO | ||||||||
| FirstName: | LISA | ||||||||
| MiddleName: | CATHERINE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 457 NORTH MAIN ST | ||||||||
| Address2: | STE 105 | ||||||||
| City: | PITTSTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 186402185 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5708839444 | ||||||||
| FaxNumber: | 5708839333 | ||||||||
| Practice Location | |||||||||
| Address1: | 457 NORTH MAIN ST | ||||||||
| Address2: | STE 105 | ||||||||
| City: | PITTSTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 186402185 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5708839444 | ||||||||
| FaxNumber: | 5708839333 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2006 | ||||||||
| LastUpdateDate: | 04/11/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | OS010595L | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 050615 | 01 | PA | MEDICARE ID - 050615 | OTHER | 65252 E187 | 01 | PA | GEISINGER GOLD | OTHER | 340964 | 01 | PW | PHS | OTHER | 0018711180001 | 05 | PA | MEDICAID | 002588 | 01 | PA | AETNA | OTHER | 002626 | 01 | PA | FIRST PRIORITY HEALTH CAP | OTHER | 2342215000 | 01 | BS PERSONAL CHOICE | OTHER | 65252 E187 | 01 | PA | GEISINGER HEALTH | OTHER | H47131 | 01 | PA | STERLING | OTHER | 1310719 | 01 | PA | FIRST PRIORITY LIFE | OTHER |