MEDICARE: MS. LYNNE ROCHELLE HRICIK

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	207QA0505X	Adult Medicine Physician	MA00946L	PA
2	363AM0700X	Medical Physician Assistant	MA000946L	PA
3	363AM0700X	Medical Physician Assistant	1010116	PA

General Provider Information

NPI Number	:	1750152948
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LYNNE ROCHELLE HRICIK

Provider Business Mailing Address
First Line	:	501 JACKSON BLVD
Second Line	:
City	:	FREEDOM
State	:	PA
Zip	:	15042-2842
Country	:	US
Telephone Number	:	724-774-3050
Fax Number	:

Provider Business Practice Location Address
First Line	:	213 EXECUTIVE DR STE 240
Second Line	:
City	:	CRANBERRY TWP
State	:	PA
Zip	:	16066-6405
Country	:	US
Telephone Number	:	724-772-9797
Fax Number	:	724-772-3309

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

Provider Enumeration Date	:	01/16/2024
Last Update Date	:	01/16/2024

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