Provider Demographics
NPI:1033280417
Name:MISTAL, DEBORAH J (DO)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:J
Last Name:MISTAL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1347
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704-0347
Mailing Address - Country:US
Mailing Address - Phone:570-288-8881
Mailing Address - Fax:570-288-8065
Practice Address - Street 1:32 WEST FOOTHILLS DRIVE
Practice Address - Street 2:
Practice Address - City:DRUMS
Practice Address - State:PA
Practice Address - Zip Code:18222
Practice Address - Country:US
Practice Address - Phone:570-788-5000
Practice Address - Fax:570-788-2325
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS005335L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009920370003Medicaid
PA5183046OtherAETNA
PA003005OtherFIRST PRIORITY HEALTH
PA89664OtherHIGHMARK BLUE SHIELD
PAP004937OtherGATEWAY HEALTH PLAN
PA39526OtherGEISINGER HEALTH PLAN
PAP004937OtherGATEWAY HEALTH PLAN
PA003005OtherFIRST PRIORITY HEALTH