Provider Demographics
NPI:1720057805
Name:GOYKOVICH, STEPHEN (DO)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:GOYKOVICH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 430
Mailing Address - Street 2:
Mailing Address - City:AVIS
Mailing Address - State:PA
Mailing Address - Zip Code:17721-0430
Mailing Address - Country:US
Mailing Address - Phone:570-753-8620
Mailing Address - Fax:570-753-5489
Practice Address - Street 1:104 E. CENTRAL AVE.
Practice Address - Street 2:
Practice Address - City:AVIS
Practice Address - State:PA
Practice Address - Zip Code:17721
Practice Address - Country:US
Practice Address - Phone:570-753-8620
Practice Address - Fax:570-753-5489
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS007685L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA080013499OtherRAILROAD MEDICARE
PA001178OtherFIRST PRIORITY HEALTH
PA5501338OtherAETNA
PA6759-C2CEOtherGEISINGER HEALTH PLAN
PA690195OtherBLUE SHIELD
PA0012612900002Medicaid
PA5501338OtherAETNA
PA080013499OtherRAILROAD MEDICARE