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General NPI Number Information
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NPI Number | 1295005429
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Entity Type | Individual
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Provider Name | ROBERT JOHN MAYSHOCK PA-C
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Gender | Male
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Dates
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Enumeration Date | 01/04/2012
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Last Update Date | 01/04/2012
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Provider Practice Location Address
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Address Line | 1100 GRAMPIAN BLVD DIVINE PROVIDENCE HOSPITAL - IPBH
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City | WILLIAMSPORT
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State | PA
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Zip | 17701-1909
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Country | US
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Telephone | 570-326-8295
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Fax |
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Provider Business Mailing Address
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Address Line | 181 PLEASANT VIEW EST
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City | TURBOTVILLE
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State | PA
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Zip | 17772-8655
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Country | US
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Telephone | 570-649-5070
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Fax |
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | MA002379L
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License Number State | PA
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