Provider Demographics
NPI:1457316606
Name:ZANCOSKY, KRYSIA LYNNE (DO)
Entity Type:Individual
Prefix:
First Name:KRYSIA
Middle Name:LYNNE
Last Name:ZANCOSKY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 TECHNOLOGY DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16001-1801
Mailing Address - Country:US
Mailing Address - Phone:724-482-6062
Mailing Address - Fax:724-482-6117
Practice Address - Street 1:104 TECHNOLOGY DR
Practice Address - Street 2:SUITE 202
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-1801
Practice Address - Country:US
Practice Address - Phone:724-482-6062
Practice Address - Fax:724-482-6117
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS012701207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAZA1774712OtherHIGHMARK
PAZA1774712OtherPA BLUE CROSS/BLUE SHIELD
PA0015853400003Medicaid
PA0015853400003Medicaid
I46187Medicare UPIN
096268QLUMedicare PIN