Provider Demographics
NPI:1881053395
Name:HYDRICK, JAIRAD S (PPAS)
Entity type:Individual
Prefix:MR
First Name:JAIRAD
Middle Name:S
Last Name:HYDRICK
Suffix:
Gender:M
Credentials:PPAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 N RIVER ST
Mailing Address - Street 2:BOX NUMBER 2110
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18711-0800
Mailing Address - Country:US
Mailing Address - Phone:803-609-7375
Mailing Address - Fax:
Practice Address - Street 1:133 N RIVER ST
Practice Address - Street 2:BOX NUMBER 2110
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18711-0800
Practice Address - Country:US
Practice Address - Phone:803-609-7375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-12
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program