Provider Demographics
NPI:1912955915
Name:PICANO, JOHN JAMES (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:JAMES
Last Name:PICANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 GENESEE ST
Mailing Address - Street 2:SUITE 600
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13501-2199
Mailing Address - Country:US
Mailing Address - Phone:315-793-8806
Mailing Address - Fax:315-793-8046
Practice Address - Street 1:1656 CHAMPLIN AVE
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-4830
Practice Address - Country:US
Practice Address - Phone:315-624-6116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1817272085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01647929Medicaid
NY040426013862OtherFIDELIS
NY181727-9OtherWC
NYP010181727OtherBCBS
NY10044432OtherCDPHP
NY225136OtherMVP
NY9600800OtherGHI
NY01224322Medicaid
NY300021951OtherRAIL ROAD MEDICARE
300021951Medicare PIN
E66347Medicare UPIN
NY51643MMedicare ID - Type Unspecified
NY31962JMedicare ID - Type Unspecified