Provider Demographics
NPI:1205898798
Name:UNIACKE, BRIAN M (MD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:M
Last Name:UNIACKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:21 WATERFORD DR
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17050-8268
Mailing Address - Country:US
Mailing Address - Phone:717-591-3630
Mailing Address - Fax:717-591-3631
Practice Address - Street 1:21 WATERFORD DR
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17050-8268
Practice Address - Country:US
Practice Address - Phone:717-591-3630
Practice Address - Fax:717-591-3631
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2021-01-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD029808E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001526340Medicaid
PAA72357Medicare UPIN
PA436432Medicare PIN
PA080098504OtherRAIL ROAD MEDICARE