Paul Licata
Individual provider Active NPI Vascular & Interventional Radiology Physician · Lewisberry, PA
NPI 1790772002 · NPPES record last updated May 24, 2021
Key facts
- NPI
- 1790772002
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Vascular & Interventional Radiology Physician 2085R0204X
- License
- MD073064L (PA)
- Practice address
- 629D Lowther Rd
Suite 3950
Lewisberry, PA 17339-9527 - Phone
- (717) 932-5200
- NPI assigned
- Oct 3, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 14
Hospital & facility affiliations 15
Medicare Care Compare profile
- Specialty
- Diagnostic Radiology
- Education
- New York University School of Medicine, 1996
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Quantum Imaging and Therapeutic Associates Inc
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
- Upmc Pinnacle Hospitals
- Upmc Hanover
- Upmc Carlisle
- Upmc Memorial
- Penn State Health Holy Spirit Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in PA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20041018000072 | PA | Practitioner - Diagnostic Radiology |
0648230326 | Reassigns benefits to 5 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Geisinger-HM Joint Venture, LLC | Diagnostic Radiology | Current | Accepting new patients |
| Regional Gastroenterology Associates of Lancaster, LTD. | Current |
Accepting new patients | |
| University of Pittsburgh Physicians | Diagnostic Radiology | Current |
Accepting new patients |
| University of Pittsburgh Physicians | Current | Accepting new patients | |
| Geisinger Clinic | Current | Accepting new patients | |
| Midatlantic Endoscopy LLC | Current | Accepting new patients | |
| Geisinger-HM Joint Venture, LLC | Current |
Accepting new patients | |
| Penn State Health Medical Group, LLC | Diagnostic Radiology | Current |
Accepting new patients |
| Geisinger Clinic | Current |
Accepting new patients | |
| Penn State Health Medical Group, LLC | Current | Accepting new patients | |
| Quantum Imaging & Therapeutic Associates Inc | Diagnostic Radiology | Current |
Accepting new patients |
| Geisinger-HM Joint Venture, LLC | Current |
Accepting new patients | |
| Regional Gastroenterology Associates of Lancaster, LTD. | Current |
Accepting new patients | |
| Central Pennsylvania MRI Center | Diagnostic Radiology | Past | Accepting new patients |
Locations
503 N 21st St
Camp Hill, PA 17011
Phone (717) 763-2100
423 N 21st St
Ste 202
Camp Hill, PA 17011
Phone (717) 763-9880
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
Ste 3950
Lewisberry, PA 17339
Phone (717) 843-0736
629D Lowther Rd
Lewisberry, PA 17339
Phone (717) 938-2765
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
200 Lothrop St
Pittsburgh, PA 15213
Phone (412) 647-3553
2 Hot Metal St
#One
Pittsburgh, PA 15203
Phone (412) 432-5864
Interoperability endpoints
- plicata489573@wellspan.direct-ci.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Vascular & Interventional Radiology Physician | 2085R0204X | MD073064L | PA | Yes |
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
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | upmchospitals@upmcdirect.com | UPMC |
Other providers in Lewisberry, PA
- Genna L Kurtz
- Philip J. Lawlis
- Benjamin Lee
- Allen Levy
- Lewisberry Community Fire Company
- Geoffrey Lindblad
- David Lynch
- Loren C Macey
- Douglas J. Martin
- Jennifer McCahan
All providers in Lewisberry, PA · Vascular & Interventional Radiology Physician in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 24, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.