Healthcare Provider Details

I. General information

NPI: 1194704239
Provider Name (Legal Business Name): BERNARD ADUKAITIS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2006
Last Update Date: 01/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 ALTAMONT BLVD
FRACKVILLE PA
17931-2412
US

IV. Provider business mailing address

602 ALTAMONT BLVD
FRACKVILLE PA
17931-2412
US

V. Phone/Fax

Practice location:
  • Phone: 570-874-2033
  • Fax: 570-874-2804
Mailing address:
  • Phone: 570-874-2033
  • Fax: 570-874-2804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberOS005106L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: