Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | OS013178 | PA |
Y | 207Q00000X | Family Doctor | OS013178 | PA |
NPI | 1336107887 |
---|---|
Provider Name | Dr. Dominic M Sciamanda |
First Address | Erie, PA 16505-4935 |
Second Address | Erie, PA 16505-4935 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2006 |
Last Update Date | 11/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1013826810002 | (05) | PA |
1968578 | BLUE CROSS/ BLUE SHIELD (01) | PA |
I42117 | (02) | PA |
P008797 | GATEWAY (01) | PA |