Provider Demographics
NPI:1053678466
Name:HUCK, PATRICK A (PA)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:A
Last Name:HUCK
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 449
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-0449
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:799 FARSON ST STE 210
Practice Address - Street 2:
Practice Address - City:BELPRE
Practice Address - State:OH
Practice Address - Zip Code:45714-1044
Practice Address - Country:US
Practice Address - Phone:740-423-3082
Practice Address - Fax:740-423-3083
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-23
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.003458RX363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0121054Medicaid
OHH272160Medicare PIN
OHH272161Medicare PIN