MEDICARE: HEATHER LYNN 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
1	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1831447960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER LYNN MYCHAK PA-C

Provider Business Mailing Address
First Line	:	116 DEFENSE HWY
Second Line	:	SUITE 403
City	:	ANNAPOLIS
State	:	MD
Zip	:	21401-7027
Country	:	US
Telephone Number	:	410-571-2946
Fax Number	:	410-571-2947

Provider Business Practice Location Address
First Line	:	2201 FOREST HILLS DR STE 7
Second Line	:
City	:	HARRISBURG
State	:	PA
Zip	:	17112-1089
Country	:	US
Telephone Number	:	717-652-5063
Fax Number	:

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

Provider Enumeration Date	:	08/21/2012
Last Update Date	:	02/06/2018

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