Provider Demographics
NPI:1932116001
Name:PRIZNIAK, DAVID T JR (PA-C)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:T
Last Name:PRIZNIAK
Suffix:JR
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 LANCASTER AVE
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17112-2258
Mailing Address - Country:US
Mailing Address - Phone:717-545-2485
Mailing Address - Fax:
Practice Address - Street 1:4TH AND WALNUT STREETS
Practice Address - Street 2:CARDIOVASCULAR SURGICAL ASSOCIATES OF LEBANON
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-1281
Practice Address - Country:US
Practice Address - Phone:717-270-3751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC5-0011979363A00000X
PAMA050827363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA058636Medicare UPIN