Provider Demographics
NPI:1558634030
Name:PRAWAK, OKSANA TATIANA (MD)
Entity Type:Individual
Prefix:DR
First Name:OKSANA
Middle Name:TATIANA
Last Name:PRAWAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 NEWPORT DR
Mailing Address - Street 2:
Mailing Address - City:CHESTERBROOK
Mailing Address - State:PA
Mailing Address - Zip Code:19087-5849
Mailing Address - Country:US
Mailing Address - Phone:610-647-4595
Mailing Address - Fax:
Practice Address - Street 1:25 NEWPORT DR
Practice Address - Street 2:
Practice Address - City:CHESTERBROOK
Practice Address - State:PA
Practice Address - Zip Code:19087-5849
Practice Address - Country:US
Practice Address - Phone:610-647-4595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-14
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD056507L208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation