Provider Demographics
NPI:1275507915
Name:CIECHOSKI, PAUL THOMAS (PA-C)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:THOMAS
Last Name:CIECHOSKI
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 PICKETT RD
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17315-3125
Mailing Address - Country:US
Mailing Address - Phone:717-668-7580
Mailing Address - Fax:
Practice Address - Street 1:175 PICKETT RD
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:PA
Practice Address - Zip Code:17315-3125
Practice Address - Country:US
Practice Address - Phone:717-668-7580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA054163363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2516439OtherHIGHMARK BLUE SHIELD-WMG
PA1589723OtherGATEWAY MEDICARE ASSURED-WMG
PA2516439OtherHIGHMARK BLUE SHIELD-WMG