Provider Demographics
NPI:1265497259
Name:MAKATCHE, TIMOTHY JOHN (DO)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:JOHN
Last Name:MAKATCHE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 448
Mailing Address - Street 2:
Mailing Address - City:EAST PETERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17520-0448
Mailing Address - Country:US
Mailing Address - Phone:717-947-7021
Mailing Address - Fax:717-391-0793
Practice Address - Street 1:5 S CENTRE AVE
Practice Address - Street 2:A3
Practice Address - City:LEESPORT
Practice Address - State:PA
Practice Address - Zip Code:19533-8653
Practice Address - Country:US
Practice Address - Phone:610-926-5707
Practice Address - Fax:610-926-8352
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS005190L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0039OtherAETNA
PA410647OtherHIGHMARK BLUE SHIELD
PA0019296480001Medicaid
PA01148101OtherCAPITAL BLUE CROSS
PAP3171383OtherOXFORD HEALTH PLAN
PA080025913OtherPALMETTO RR MEDICARE
PA000000143853OtherUNISON AB
PA100278BOtherAMERIHEALTH MERCY
PA100278BOtherAMERIHEALTH MERCY
PAP3171383OtherOXFORD HEALTH PLAN