Healthcare Provider Details

I. General information

NPI: 1750292413
Provider Name (Legal Business Name): MARTA TYMCHENKO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 S 5TH AVE
WEST READING PA
19611-2143
US

IV. Provider business mailing address

420 S 5TH AVE
WEST READING PA
19611-2143
US

V. Phone/Fax

Practice location:
  • Phone: 267-221-0245
  • Fax:
Mailing address:
  • Phone: 267-221-0245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberOA007810
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP01045000
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA068010
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: