Healthcare Provider Details

I. General information

NPI: 1083750137
Provider Name (Legal Business Name): DAWN MCCRACKEN M.D. PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 01/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3379 PITTSBURGH RD BOX 621
PERRYOPOLIS PA
15473-0621
US

IV. Provider business mailing address

3379 PITTSBURGH RD BOX 621
PERRYOPOLIS PA
15473-0621
US

V. Phone/Fax

Practice location:
  • Phone: 724-736-2481
  • Fax: 724-736-2483
Mailing address:
  • Phone: 724-736-2481
  • Fax: 724-736-2483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD058231L
License Number StatePA

VIII. Authorized Official

Name: DAWN RENEE MCCRACKEN
Title or Position: OWNER
Credential: M.D.
Phone: 724-736-2481