Provider Demographics
NPI:1063412088
Name:LACAVA, THERESA (MD)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:LACAVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1070 OLD NATIONAL PIKE
Mailing Address - Street 2:
Mailing Address - City:FREDERICKTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15333-2114
Mailing Address - Country:US
Mailing Address - Phone:724-632-6801
Mailing Address - Fax:724-632-6312
Practice Address - Street 1:86 MCCLELLANDTOWN RD
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401-5527
Practice Address - Country:US
Practice Address - Phone:724-430-7990
Practice Address - Fax:724-430-7993
Is Sole Proprietor?:No
Enumeration Date:2005-08-01
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA063299L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000833D4ZOtherHGSA MEDICARE
PA75016OtherMEDPLUS
PAP001082OtherGATEWAY
PA139508OtherHIGHMARK
PA080143282OtherRAILROAD MEDICARE
PA1115189OtherUPMC
PA0016639200009Medicaid
PA080143282OtherRAILROAD MEDICARE