Provider Demographics
NPI:1467409771
Name:FLICKINGER, JOHN W JR (PA-C)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:FLICKINGER
Suffix:JR
Gender:M
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 1:464 ALLEGHENY BLVD
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:PA
Mailing Address - Zip Code:16323-6210
Mailing Address - Country:US
Mailing Address - Phone:814-432-7327
Mailing Address - Fax:814-437-6225
Practice Address - Street 1:464 ALLEGHENY BLVD
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:PA
Practice Address - Zip Code:16323-6210
Practice Address - Country:US
Practice Address - Phone:814-432-7327
Practice Address - Fax:814-437-6225
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA051339363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA080930HW4Medicare ID - Type Unspecified
Q19603Medicare UPIN