Healthcare Provider Details

I. General information

NPI: 1730747858
Provider Name (Legal Business Name): JACOB ANTHONY PARRICK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2019
Last Update Date: 02/10/2022
Certification Date: 02/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 S WASHINGTON AVE STE 1000
SCRANTON PA
18505-3814
US

IV. Provider business mailing address

970 RIDGE AVE APT 4
SCRANTON PA
18510-1483
US

V. Phone/Fax

Practice location:
  • Phone: 570-230-0019
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD476294
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMT217805
License Number StatePA

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: