Healthcare Provider Details

I. General information

NPI: 1972273274
Provider Name (Legal Business Name): TRAVIS GEORGE HUNYARA PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2021
Last Update Date: 09/17/2021
Certification Date: 09/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 NORMAN DR
LEBANON PA
17042-3704
US

IV. Provider business mailing address

233 MOONHILL DR
SCHUYLKILL HAVEN PA
17972-9360
US

V. Phone/Fax

Practice location:
  • Phone: 717-273-6706
  • Fax:
Mailing address:
  • Phone: 570-640-5173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA062952
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: