Provider Demographics
NPI:1437200755
Name:OPIDA, CICERON L (MD)
Entity type:Individual
Prefix:DR
First Name:CICERON
Middle Name:L
Last Name:OPIDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 CHESTNUT AVE
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16601-4911
Mailing Address - Country:US
Mailing Address - Phone:814-946-5000
Mailing Address - Fax:814-944-3523
Practice Address - Street 1:310 CHESTNUT AVE
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16601-4911
Practice Address - Country:US
Practice Address - Phone:814-946-5000
Practice Address - Fax:814-944-3523
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA020833E2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007516800008Medicaid
PA026452Medicare PIN
PA0007516800002Medicaid