Provider Demographics
NPI:1629433925
Name:MACHAK, RAYMOND (PA)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:
Last Name:MACHAK
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7327 MEADOWLARK DR
Mailing Address - Street 2:
Mailing Address - City:TOBYHANNA
Mailing Address - State:PA
Mailing Address - Zip Code:18466-3302
Mailing Address - Country:US
Mailing Address - Phone:917-913-6443
Mailing Address - Fax:
Practice Address - Street 1:7327 MEADOWLARK DR
Practice Address - Street 2:
Practice Address - City:TOBYHANNA
Practice Address - State:PA
Practice Address - Zip Code:18466-3302
Practice Address - Country:US
Practice Address - Phone:917-913-6443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-31
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPA2007-0021363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant