Provider Demographics
NPI:1245224401
Name:YACYK, MARK JOSEPH (DO)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:JOSEPH
Last Name:YACYK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11110 MEDICAL CAMPUS RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-6700
Mailing Address - Country:US
Mailing Address - Phone:301-665-4950
Mailing Address - Fax:301-665-4956
Practice Address - Street 1:11110 MEDICAL CAMPUS RD
Practice Address - Street 2:SUITE 205
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-6700
Practice Address - Country:US
Practice Address - Phone:301-665-4950
Practice Address - Fax:301-665-4956
Is Sole Proprietor?:No
Enumeration Date:2005-09-02
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH00461082081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD282871500Medicaid
MD282871500Medicaid
PA0449950002Medicare NSC
WVYA4162551Medicare ID - Type Unspecified
MD415L049CMedicare ID - Type Unspecified
F87737Medicare UPIN