Provider Demographics
NPI:1760659635
Name:KACHIK, LARRY JOHN (MD)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:JOHN
Last Name:KACHIK
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 1:135 KENNEDY RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15725-8701
Mailing Address - Country:US
Mailing Address - Phone:412-780-1040
Mailing Address - Fax:
Practice Address - Street 1:135 KENNEDY RD
Practice Address - Street 2:
Practice Address - City:CLARKSBURG
Practice Address - State:PA
Practice Address - Zip Code:15725-8701
Practice Address - Country:US
Practice Address - Phone:412-780-1040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-10
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD023722E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine