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General NPI Number Information
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NPI Number | 1265497259
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Entity Type | Individual
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Provider Name | TIMOTHY JOHN MAKATCHE DO
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Gender | Male
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Dates
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Enumeration Date | 04/20/2006
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Last Update Date | 12/19/2018
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Provider Practice Location Address
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Address Line | 5 S CENTRE AVE A3
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City | LEESPORT
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State | PA
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Zip | 19533-8653
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Country | US
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Telephone | 610-926-5707
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Fax | 610-926-8352
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Provider Business Mailing Address
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Address Line | PO BOX 448
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City | EAST PETERSBURG
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State | PA
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Zip | 17520-0448
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Country | US
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Telephone | 717-947-7021
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Fax | 717-391-0793
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OS005190L
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License Number State | PA
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