Provider Demographics
NPI:1447576673
Name:KNESTRICK, MARK WAYNE (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:WAYNE
Last Name:KNESTRICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:470 JOHNSON RD STE 10
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-8944
Mailing Address - Country:US
Mailing Address - Phone:724-223-3816
Mailing Address - Fax:724-223-4079
Practice Address - Street 1:470 JOHNSON RD STE 10
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-8944
Practice Address - Country:US
Practice Address - Phone:724-223-3816
Practice Address - Fax:724-223-4079
Is Sole Proprietor?:No
Enumeration Date:2010-04-13
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101260907207RX0202X
PAMD474898207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1447576673Medicaid