Provider Demographics
NPI:1548223399
Name:PUHALLA, CYRIL (MD)
Entity Type:Individual
Prefix:
First Name:CYRIL
Middle Name:
Last Name:PUHALLA
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 1:326 ADAMS AVE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18503-1604
Mailing Address - Country:US
Mailing Address - Phone:570-348-6100
Mailing Address - Fax:570-969-8626
Practice Address - Street 1:326 ADAMS AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18503-1604
Practice Address - Country:US
Practice Address - Phone:570-348-6100
Practice Address - Fax:570-969-8626
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD015383E2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0005566850004Medicaid
PA0005566850004Medicaid