Healthcare Provider Details

I. General information

NPI: 1043259518
Provider Name (Legal Business Name): RONALD BRIAN MEZICK JR. PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 04/26/2022
Certification Date: 04/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

246 S MAIN ST
HUGHESVILLE PA
17737-1614
US

IV. Provider business mailing address

7 DOCK HILL RD
MIDDLEBURG PA
17842-8910
US

V. Phone/Fax

Practice location:
  • Phone: 570-584-5144
  • Fax: 570-584-5416
Mailing address:
  • Phone: 570-837-2123
  • Fax: 570-837-2185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA000153L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: