Basic Information
| Provider Information | |||||||||
| NPI: | 1982658050 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DERRICO | ||||||||
| FirstName: | ANNE-MARIE | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 304 N WATER ST | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 176033374 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172996371 | ||||||||
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| Practice Location | |||||||||
| Address1: | 304 N WATER ST | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 176033374 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172996371 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2006 | ||||||||
| LastUpdateDate: | 03/20/2018 | ||||||||
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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 | MD417665 | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 001408780 | 01 | PA | HIGHMARK | OTHER | 001957203 0001 | 05 | PA | MEDICAID | 20043244 | 01 | PA | MERCY | OTHER | 261327 | 01 | PA | HEALTHAMERICA | OTHER | P004949 | 01 | PA | GATEWAY | OTHER | 50055951 | 01 | PA | KEYSTONE HEALTH PLAN CENTRAL | OTHER | P00023026 | 01 | PA | RR MEDICARE | OTHER | 000000257383 | 01 | PA | UNISON | OTHER | 7147679 | 01 | PA | AETNA-NON HMO | OTHER | 1089231 | 01 | PA | AETNA-HMO | OTHER | 2096244000 | 01 | PA | INDEPENDENCE BLUE CROSS | OTHER | 50055951 | 01 | PA | CAPITAL BLUE CROSS | OTHER |