Healthcare Provider Details

I. General information

NPI: 1457403750
Provider Name (Legal Business Name): PHYSICIANCARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 09/14/2022
Certification Date: 09/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71 HOSPITAL DRIVE
TOWANDA PA
18848-9706
US

IV. Provider business mailing address

71 HOSPITAL DR
TOWANDA PA
18848-9702
US

V. Phone/Fax

Practice location:
  • Phone: 570-265-6300
  • Fax: 570-268-2807
Mailing address:
  • Phone: 570-265-6300
  • Fax: 570-268-2807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: ANGELA TAMA ZANG
Title or Position: PRESIDENT/OWNER
Credential: MD
Phone: 570-265-6300