Healthcare Provider Details

I. General information

NPI: 1790678803
Provider Name (Legal Business Name): MADISON ZOLOCSIK PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MADISON BRESNEHAN

II. Dates (important events)

Enumeration Date: 05/29/2025
Last Update Date: 11/06/2025
Certification Date: 11/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HOSPITAL AVE
DU BOIS PA
15801-1440
US

IV. Provider business mailing address

1777 BRADY RD
MARION CENTER PA
15759-6813
US

V. Phone/Fax

Practice location:
  • Phone: 814-371-2200
  • Fax:
Mailing address:
  • Phone: 724-991-7170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: