Provider Demographics
NPI:1972013233
Name:NIEDERMYER, MARK PATRICK (PA-C)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:PATRICK
Last Name:NIEDERMYER
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4903
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:570-271-6578
Practice Address - Street 1:100 N ACADEMY AVE
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:PA
Practice Address - Zip Code:17822-9118
Practice Address - Country:US
Practice Address - Phone:570-271-6541
Practice Address - Fax:570-271-5872
Is Sole Proprietor?:No
Enumeration Date:2017-10-02
Last Update Date:2020-08-31
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant