Provider Demographics
NPI:1649548181
Name:MAGERA, JOHN (MAC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:MAGERA
Suffix:
Gender:M
Credentials:MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:836 OAK RD
Mailing Address - Street 2:
Mailing Address - City:BRADFORDWOODS
Mailing Address - State:PA
Mailing Address - Zip Code:15015-1208
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:836 OAK RD
Practice Address - Street 2:
Practice Address - City:BRADFORDWOODS
Practice Address - State:PA
Practice Address - Zip Code:15015-1208
Practice Address - Country:US
Practice Address - Phone:724-799-4230
Practice Address - Fax:724-935-2342
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-12
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAKO000584171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist