MEDICARE: MADISON MACKNOSKY 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
1	363A00000X	Physician Assistant	MA067276	PA

General Provider Information

NPI Number	:	1679434732
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADISON MACKNOSKY PA-C

Provider Business Mailing Address
First Line	:	50 WHITE TAIL LN
Second Line	:
City	:	SCOTT TOWNSHIP
State	:	PA
Zip	:	18447-7673
Country	:	US
Telephone Number	:	570-241-8168
Fax Number	:

Provider Business Practice Location Address
First Line	:	50 WHITE TAIL LN
Second Line	:
City	:	SCOTT TOWNSHIP
State	:	PA
Zip	:	18447-7673
Country	:	US
Telephone Number	:	570-241-8168
Fax Number	:

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

Provider Enumeration Date	:	11/19/2025
Last Update Date	:	02/03/2026

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