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NPI Code Detail

MEDICARE: RICHARD WAYNE MONDAK MPAS PA-C

MEDICARE: RICHARD WAYNE MONDAK MPAS 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
1363AM0700XMedical Physician AssistantMA002019LPA

General Provider Information

NPI Number : 1720078017
Entity Type Code : Individual
Provider Name (Legal Business Name) : RICHARD WAYNE MONDAK MPAS PA-C
Provider Business Mailing Address
First Line : 510 JAMISON AVE
Second Line :
City : ELLWOOD CITY
State : PA
Zip : 16117-2590
Country : US
Telephone Number : 724-716-6742
Fax Number : 724-734-5798
Provider Business Practice Location Address
First Line : 510 JAMISON AVE
Second Line :
City : ELLWOOD CITY
State : PA
Zip : 16117-2590
Country : US
Telephone Number : 724-716-6742
Fax Number : 724-734-5798
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/27/2005
Last Update Date : 11/29/2016

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Directions to “ RICHARD WAYNE MONDAK MPAS PA-C” Practice Location

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