Provider Demographics
NPI:1063521755
Name:DORIA SCORTICHINI MD FACC PLLC
Entity type:Organization
Organization Name:DORIA SCORTICHINI MD FACC PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DORIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:SCORTICHINI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-789-5758
Mailing Address - Street 1:1150 ROUTES 5 & 20
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:NY
Mailing Address - Zip Code:14456
Mailing Address - Country:US
Mailing Address - Phone:315-789-5758
Mailing Address - Fax:315-789-0741
Practice Address - Street 1:1150 ROUTES 5 & 20
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:NY
Practice Address - Zip Code:14456
Practice Address - Country:US
Practice Address - Phone:315-789-5758
Practice Address - Fax:315-789-0741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02576176Medicaid
G0189671370OtherBLUE CHOICE
NYBA0279Medicare PIN