Provider Demographics
NPI:1518937457
Name:PRIMACK, JONATHAN D (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:D
Last Name:PRIMACK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1 GRANITE POINT DR STE 100
Mailing Address - Street 2:
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-1992
Mailing Address - Country:US
Mailing Address - Phone:610-378-1344
Mailing Address - Fax:610-378-5169
Practice Address - Street 1:1 GRANITE POINT DR STE 100
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-1992
Practice Address - Country:US
Practice Address - Phone:610-378-1344
Practice Address - Fax:610-378-5169
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD427795207W00000X, 207WX0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0120XAllopathic & Osteopathic PhysiciansOphthalmologyCornea and External Diseases Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1014930630001Medicaid
PA1014930630004Medicaid
PA1014930630003Medicaid
PAP00295248OtherRAILROAD MEDICARE