Provider Demographics
NPI:1356867287
Name:CHERMAK, MARCELLA (PA-C)
Entity Type:Individual
Prefix:
First Name:MARCELLA
Middle Name:
Last Name:CHERMAK
Suffix:
Gender:F
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 1:1111 E END BLVD
Mailing Address - Street 2:
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18711-0030
Mailing Address - Country:US
Mailing Address - Phone:570-824-3521
Mailing Address - Fax:
Practice Address - Street 1:300 LACKAWANNA AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18503-2001
Practice Address - Country:US
Practice Address - Phone:570-961-3823
Practice Address - Fax:570-207-5988
Is Sole Proprietor?:No
Enumeration Date:2017-08-22
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA059217363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant