Provider Demographics
NPI:1437113099
Name:KUCHARCZUK & SMITH INC
Entity Type:Organization
Organization Name:KUCHARCZUK & SMITH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:B
Authorized Official - Last Name:KUCHARCZUK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-262-9091
Mailing Address - Street 1:1357 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18067-1613
Mailing Address - Country:US
Mailing Address - Phone:610-262-9091
Mailing Address - Fax:610-262-1566
Practice Address - Street 1:1357 MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18067-1613
Practice Address - Country:US
Practice Address - Phone:610-262-9091
Practice Address - Fax:610-262-1566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-12
Last Update Date:2009-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD023597-L207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0643566Medicaid
PAB31696Medicare ID - Type Unspecified
PA0643566Medicaid