Healthcare Provider Details

I. General information

NPI: 1619403243
Provider Name (Legal Business Name): JOSEPH WILLIAM RADACHY DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2017
Last Update Date: 06/30/2020
Certification Date: 06/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 STATE ST
ERIE PA
16550-0002
US

IV. Provider business mailing address

201 STATE ST
ERIE PA
16550-0002
US

V. Phone/Fax

Practice location:
  • Phone: 814-877-6139
  • Fax: 814-877-6093
Mailing address:
  • Phone: 814-877-6139
  • Fax: 814-877-6093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number304000-01
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberOS019765
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: