MEDICARE: DR. MICHAEL DANIEL HAROSTOCK M.D.9

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	MD028903E	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	432226	OTHER	PA	MEDICARE #

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	798833	OTHER	PA	UNITED HEALTHCARE
4	378976	OTHER	PW	HEALTH AMERICA

General Provider Information

NPI Number	:	1013915008
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL DANIEL HAROSTOCK M.D.9

Provider Business Mailing Address
First Line	:	100 NORTH ACADEMY AVE.
Second Line	:
City	:	DANVILLE
State	:	PA
Zip	:	17822-4903
Country	:	US
Telephone Number	:	570-271-6144
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 E MOUNTAIN BLVD
Second Line	:
City	:	WILKES BARRE
State	:	PA
Zip	:	18711-0027
Country	:	US
Telephone Number	:	570-808-6020
Fax Number	:	570-808-2306

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	08/20/2020

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Directions to “ DR. MICHAEL DANIEL HAROSTOCK M.D.9” Practice Location

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