Provider Demographics
NPI:1346310984
Name:GARCIA, MAGDIEL (CRNP)
Entity Type:Individual
Prefix:
First Name:MAGDIEL
Middle Name:
Last Name:GARCIA
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 ERDMAN ST
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:PA
Mailing Address - Zip Code:18013-2043
Mailing Address - Country:US
Mailing Address - Phone:610-588-2225
Mailing Address - Fax:610-588-2292
Practice Address - Street 1:225 ERDMAN ST
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:PA
Practice Address - Zip Code:18013-2043
Practice Address - Country:US
Practice Address - Phone:610-588-2225
Practice Address - Fax:610-588-2292
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP012758363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP38305OtherAMERIHEALTH
PA50033226OtherCAPITAL BLUE CROSS
PA660979OtherUNITED HEALTHCARE
PA2795062OtherHIGHMARK BLUE SHIELD
PA660979OtherUNITED HEALTHCARE