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1200 Aleeda Blvd Bear Creek Township PA 18702-9611 | |
(570) 829-1095 | |
Not Available |
Full Name | |
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Speciality | Family Medicine |
Location | 1200 Aleeda Blvd, Bear Creek Township, Pennsylvania |
Authorized Official Name and Position | Mario Cornacchione (OWNER) |
Authorized Official Contact | 5708291095 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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1200 Aleeda Blvd Bear Creek Township PA 18702-9611 Ph: (570) 829-1095 | 1200 Aleeda Blvd Bear Creek Township PA 18702-9611 Ph: (570) 829-1095 |
NPI Number | 1003074600 |
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Provider Enumeration Date | 05/30/2008 |
Last Update Date | 07/10/2008 |
Medicare PECOS PAC ID | 2365517935 |
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Medicare Enrollment ID | O20080815000315 |
Identifier | Type | State | Issuer |
---|---|---|---|
1003074600 | NPI | - | NPPES |
OS005253 | Other | PA | MEDICAL LICENSE |
Taxonomy | Type | License (State) | Status |
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207QG0300X | Family Medicine - Geriatric Medicine | OS005253L (Pennsylvania) | Primary |
Provider Name | Mario J Cornacchione |
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Provider Type | Practitioner - Geriatric Medicine |
Provider Identifiers | NPI Number: 1194807503 PECOS PAC ID: 1850308644 Enrollment ID: I20060320000671 |