NPIMap

Individual provider Active NPI

Paul Licata

  • Vascular & Interventional Radiology Physician
  • Lewisberry, PA
National Provider Identifier
1790772002
Registry record updated May 24, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular & Interventional Radiology PhysicianTaxonomy code 2085R0204X
License
MD073064L Issued in PA
Practice address
629D Lowther Rd
Suite 3950
Lewisberry, PA 17339-9527
Phone
(717) 932-5200
NPI assigned
Oct 3, 2005
Last updated
May 24, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 24, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular & Interventional Radiology Physician 2085R0204X MD073064L PA Primary

Addresses

Primary practice location

629D Lowther Rd
Suite 3950
Lewisberry, PA 17339-9527

Mailing address

629D Lowther Rd
Suite 3950
Lewisberry, PA 17339-9527

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address upmchospitals@upmcdirect.com UPMC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041018000072 PA Practitioner - Diagnostic RadiologyPractitioner - Interventional Radiology 0648230326 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic RadiologyAlso: Interventional Radiology
Education
New York University School of Medicine, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1500 Highlands Dr
Lititz, PA 17543-7694
Phone (717) 932-5200

1995 Technology Pkwy
Mechanicsburg, PA 17050-8522
Phone (717) 932-5200

2015 Technology Pkwy
Mechanicsburg, PA 17050-9414
Phone (717) 932-5200

300 Highland Ave
Hanover, PA 17331-2297
Phone (717) 932-5200

361 Alexander Spring Rd
Carlisle, PA 17015-6940
Phone (717) 932-5200

4300 Londonderry Rd
Harrisburg, PA 17109-5317
Phone (717) 932-5200

4518 Union Deposit Rd
Harrisburg, PA 17111-2921
Phone (717) 932-5200

5006 Pellingham Cir
Enola, PA 17025-1293
Phone (717) 932-5200

5026 Pellingham Cir
Enola, PA 17025-1293
Phone (717) 932-5200

503 N 21St St
Camp Hill, PA 17011-2204
Phone (717) 932-5200

51 Business Campus Way
Suite 100
Duncannon, PA 17020-9596
Phone (717) 932-5200

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Geisinger-HM Joint Venture, LLC CurrentSince Mar 1, 2020 Accepting new patients
Geisinger-HM Joint Venture, LLC Diagnostic Radiology Current Accepting new patients
Regional Gastroenterology Associates of Lancaster, LTD. CurrentSince Feb 1, 2020 Accepting new patients
Geisinger Clinic CurrentSince Oct 27, 2016 Accepting new patients
Midatlantic Endoscopy LLC Current Accepting new patients
University of Pittsburgh Physicians Diagnostic Radiology CurrentSince May 7, 2022 Accepting new patients
Regional Gastroenterology Associates of Lancaster, LTD. CurrentSince Feb 1, 2020 Accepting new patients
Geisinger Clinic Current Accepting new patients
Penn State Health Medical Group, LLC Diagnostic Radiology CurrentSince Oct 1, 2022 Accepting new patients
Quantum Imaging & Therapeutic Associates Inc Diagnostic Radiology CurrentSince Dec 1, 2004 Accepting new patients
University of Pittsburgh Physicians Current Accepting new patients
Geisinger-HM Joint Venture, LLC CurrentSince Mar 1, 2020 Accepting new patients
Penn State Health Medical Group, LLC Current Accepting new patients
Central Pennsylvania MRI Center Diagnostic Radiology Past Accepting new patients

Locations

423 N 21st St
Ste 202
Camp Hill, PA 17011
Phone (717) 763-9880

503 N 21st St
Camp Hill, PA 17011
Phone (717) 763-2461

100 N Academy Ave
Danville, PA 17822

51 Business Campus Way
Ste 100
Duncannon, PA 17020
Phone (717) 834-3280

111 S Front St
Harrisburg, PA 17101
Phone (717) 782-3282

1120 Cocoa Ave
Hershey, PA 17033
Phone (717) 533-4141

2112 Harrisburg Pike
Ste 202
Lancaster, PA 17601
Phone (717) 544-3500

629D Lowther Rd
Lewisberry, PA 17339
Phone (717) 938-2765

629D Lowther Rd
Ste 3950
Lewisberry, PA 17339
Phone (717) 843-0736

955 Bellefonte Ave
Lock Haven, PA 17745
Phone (570) 748-7714

4300 Londonderry Rd
Lower Paxton, PA 17109
Phone (717) 597-7044

10 Choate Cir
Montoursville, PA 17754
Phone (570) 368-5566

2 Hot Metal St
#One
Pittsburgh, PA 15203
Phone (412) 432-5864

200 Lothrop St
Pittsburgh, PA 15213
Phone (412) 647-3553

Interoperability endpoints

  • Direct secure messaging: plicata489573@wellspan.direct-ci.com

Organizations & group practices 14

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

View all 14

Hospital & facility affiliations 15

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 15

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1128297600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621814400000",
    "number": "1790772002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "629D LOWTHER RD",
            "address_2": "SUITE 3950",
            "city": "LEWISBERRY",
            "state": "PA",
            "postal_code": "173399527"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "629D LOWTHER RD",
            "address_2": "SUITE 3950",
            "city": "LEWISBERRY",
            "state": "PA",
            "postal_code": "173399527",
            "telephone_number": "717-932-5200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LICATA",
        "first_name": "PAUL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-03",
        "last_updated": "2021-05-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "PA",
            "license": "MD073064L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "upmchospitals@upmcdirect.com",
            "affiliation": "Y",
            "affiliationName": "UPMC",
            "address_1": "600 Grant St",
            "address_2": "Floor 58",
            "city": "Pittsburgh",
            "state": "PA",
            "country_code": "US",
            "postal_code": "152192702",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Lewisberry, PA

Sources for this page

Verify at the official NPI Registry.