Healthcare Provider Details

I. General information

NPI: 1063405918
Provider Name (Legal Business Name): MICHAEL J TUROCK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/25/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

397 N 9TH AVE
SCRANTON PA
18504-2005
US

IV. Provider business mailing address

397 N 9TH AVE
SCRANTON PA
18504-2005
US

V. Phone/Fax

Practice location:
  • Phone: 570-344-8619
  • Fax: 570-344-3230
Mailing address:
  • Phone: 570-344-8619
  • Fax: 570-344-3230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD013495E
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier002608
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerFIRST PRIORITY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: