Healthcare Provider Details

I. General information

NPI: 1073515292
Provider Name (Legal Business Name): JOHN P. JANCARIK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 01/04/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

824 CALIFORNIA AVE
AVALON PA
15202-2706
US

IV. Provider business mailing address

824 CALIFORNIA AVE
AVALON PA
15202-2706
US

V. Phone/Fax

Practice location:
  • Phone: 412-766-3232
  • Fax: 412-766-1306
Mailing address:
  • Phone: 412-766-3232
  • Fax: 412-766-1306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number35084464
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberMD074336
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier251423634027
Identifier TypeOTHER
Identifier StateWV
Identifier IssuerMT. STATE BC/BS
# 2
Identifier7383591
Identifier TypeOTHER
Identifier State
Identifier IssuerAETNA
# 3
Identifier1541459
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 4
Identifier245504
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerHEALTH AM./ASSUR.
# 5
Identifier2497981
Identifier TypeMEDICAID
Identifier StateOH
Identifier Issuer
# 6
Identifier1010919060003
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 7
Identifier410364
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerUPMC
# 8
Identifier000000337048
Identifier TypeOTHER
Identifier StateOH
Identifier IssuerANTHEM BC/BS
# 9
Identifier1620798
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerHIGHMARK BC/BS
# 10
Identifier000000157621
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: