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NPI Code Detail

MEDICARE: MR. NATHAN MYCHAK PA-C

MEDICARE: MR. NATHAN MYCHAK PA-C
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
1363A00000XPhysician Assistant2552OK
2363A00000XPhysician AssistantC0004713MD
3363A00000XPhysician Assistant057046PA

General Provider Information

NPI Number : 1255603510
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. NATHAN MYCHAK PA-C
Provider Business Mailing Address
First Line : 157 BALTIMORE ST STE 100
Second Line :
City : CUMBERLAND
State : MD
Zip : 21502-2472
Country : US
Telephone Number : 301-722-0484
Fax Number : 833-903-0130
Provider Business Practice Location Address
First Line : 157 BALTIMORE ST STE 100
Second Line :
City : CUMBERLAND
State : MD
Zip : 21502-2472
Country : US
Telephone Number : 301-722-0484
Fax Number : 833-903-0130
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/02/2012
Last Update Date : 02/25/2026

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Directions to “ MR. NATHAN MYCHAK PA-C” Practice Location

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