Provider Demographics
NPI:1720078017
Name:MONDAK, RICHARD WAYNE (MPAS PA-C)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:WAYNE
Last Name:MONDAK
Suffix:
Gender:M
Credentials:MPAS PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:510 JAMISON AVE
Mailing Address - Street 2:
Mailing Address - City:ELLWOOD CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16117-2590
Mailing Address - Country:US
Mailing Address - Phone:724-716-6742
Mailing Address - Fax:724-734-5798
Practice Address - Street 1:510 JAMISON AVE
Practice Address - Street 2:
Practice Address - City:ELLWOOD CITY
Practice Address - State:PA
Practice Address - Zip Code:16117-2590
Practice Address - Country:US
Practice Address - Phone:724-716-6742
Practice Address - Fax:724-734-5798
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA002019L363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical