Provider Demographics
NPI:1578621322
Name:PATRICK J MCANDREW PC
Entity Type:Organization
Organization Name:PATRICK J MCANDREW PC
Other - Org Name:MCANDREW & HALEY PC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:CURTIS
Authorized Official - Last Name:HALEY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:570-785-3194
Mailing Address - Street 1:111 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:VANDLING
Mailing Address - State:PA
Mailing Address - Zip Code:18421-1711
Mailing Address - Country:US
Mailing Address - Phone:570-785-3194
Mailing Address - Fax:570-785-9775
Practice Address - Street 1:111 MAIN ST
Practice Address - Street 2:
Practice Address - City:VANDLING
Practice Address - State:PA
Practice Address - Zip Code:18421-1711
Practice Address - Country:US
Practice Address - Phone:570-785-3194
Practice Address - Fax:570-785-9775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA05009640L207Q00000X
PA05002860L208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00686447Medicaid
PA002912OtherFIRST PRIORITY
PA01703829Medicaid
PA51793OtherGEISINGER
PA01703829Medicaid
014767RS0Medicare ID - Type Unspecified
PA51793OtherGEISINGER
147451RS0Medicare ID - Type Unspecified