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General NPI Number Information
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NPI Number | 1225996812
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Entity Type | Organization
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Legal Business Name | RADIANCE MED SPA
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Dates
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Enumeration Date | 01/12/2026
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Last Update Date | 01/12/2026
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Provider Practice Location Address
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Address Line | 11 BLUE MARLIN WAY
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City | MECHANICSBURG
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State | PA
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Zip | 17050-7660
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Country | US
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Telephone | 717-516-8272
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Fax |
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Provider Business Mailing Address
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Address Line | 11 BLUE MARLIN WAY
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City | MECHANICSBURG
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State | PA
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Zip | 17050-7660
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Country | US
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Telephone | 717-516-8272
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | MARK MASSAK
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Credential | DO
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Telephone | 717-516-8272
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number |
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License Number State |
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