Provider Demographics
NPI:1215983390
Name:MICHALAK, DARRIN MICHAEL (PA-C)
Entity type:Individual
Prefix:
First Name:DARRIN
Middle Name:MICHAEL
Last Name:MICHALAK
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ONE MEDICAL CENTER DRIVE
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03756-0001
Mailing Address - Country:US
Mailing Address - Phone:603-650-8509
Mailing Address - Fax:603-650-6061
Practice Address - Street 1:1 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03756-1000
Practice Address - Country:US
Practice Address - Phone:603-650-8509
Practice Address - Fax:603-650-6061
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA001755L363AM0700X
NH0892363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
50053516OtherCAPITAL BLUE CROSS
P00266373OtherRAILROAD MEDICARE
PA2002230OtherKEYSTONE HEALTH PLAN
S72241Medicare UPIN
PA093469Medicare PIN