Provider Demographics
NPI:1154605772
Name:MICHAEL A. WASHINSKY, DO
Entity type:Organization
Organization Name:MICHAEL A. WASHINSKY, DO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:WASHINSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:570-459-2226
Mailing Address - Street 1:1730 E BORAD STREET
Mailing Address - Street 2:SUITE1
Mailing Address - City:HAZLETON
Mailing Address - State:PA
Mailing Address - Zip Code:18201
Mailing Address - Country:US
Mailing Address - Phone:570-459-2226
Mailing Address - Fax:570-459-2511
Practice Address - Street 1:1730 E BORAD STREET
Practice Address - Street 2:SUITE1
Practice Address - City:HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18201
Practice Address - Country:US
Practice Address - Phone:570-459-2226
Practice Address - Fax:570-459-2511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-30
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS003956L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA025402Medicare PIN
PAD77323Medicare UPIN