Provider Demographics
NPI:1366505174
Name:HROBUCHAK, GARY ALLAN (DPM)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:ALLAN
Last Name:HROBUCHAK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:ROUTE 940 PO BOX 7
Mailing Address - Street 2:
Mailing Address - City:BLAKESLEE
Mailing Address - State:PA
Mailing Address - Zip Code:18610-0007
Mailing Address - Country:US
Mailing Address - Phone:570-643-1398
Mailing Address - Fax:570-646-4448
Practice Address - Street 1:395 ROUTE 940
Practice Address - Street 2:SUITE 105
Practice Address - City:BLAKESLEE
Practice Address - State:PA
Practice Address - Zip Code:18610-0007
Practice Address - Country:US
Practice Address - Phone:570-643-1398
Practice Address - Fax:570-646-4448
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PASC004304L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA6363210001Medicare NSC
PAU64966Medicare UPIN
PA692156Medicare PIN