Provider Demographics
NPI:1982645776
Name:MOTACKI, JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:MOTACKI
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 1:3550 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-8626
Mailing Address - Country:US
Mailing Address - Phone:717-851-6340
Mailing Address - Fax:717-851-6349
Practice Address - Street 1:3550 CONCORD RD
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-8626
Practice Address - Country:US
Practice Address - Phone:717-851-6340
Practice Address - Fax:717-851-6349
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4227092084P0800X, 2084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA645695 (01)OtherBC/BS OF MD CARE FIRST
PAP00289411OtherMEDICARE RAILROAD
PA1729356OtherPA BLUE SHIELD
PA2144098OtherMAMSI
PA2234318OtherCIGNA BEHAVIORAL HEALTH
PA50048786OtherCAPITAL BLUE CROSS
PA537536OtherVALUE OPTIONS
PA101249144Medicaid
PA794369000OtherMAGELLAN
PA28049Medicare UPIN
PA50048786OtherCAPITAL BLUE CROSS