Provider Demographics
NPI:1194704239
Name:ADUKAITIS, BERNARD (DO)
Entity type:Individual
Prefix:DR
First Name:BERNARD
Middle Name:
Last Name:ADUKAITIS
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 1:602 ALTAMONT BLVD
Mailing Address - Street 2:
Mailing Address - City:FRACKVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17931-2412
Mailing Address - Country:US
Mailing Address - Phone:570-874-2033
Mailing Address - Fax:570-874-2804
Practice Address - Street 1:602 ALTAMONT BLVD
Practice Address - Street 2:
Practice Address - City:FRACKVILLE
Practice Address - State:PA
Practice Address - Zip Code:17931-2412
Practice Address - Country:US
Practice Address - Phone:570-874-2033
Practice Address - Fax:570-874-2804
Is Sole Proprietor?:No
Enumeration Date:2006-01-16
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS005106L208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAE63618Medicaid
PAE63618Medicare UPIN
PA135523JPUMedicare ID - Type Unspecified