Provider Demographics
NPI:1285608380
Name:MACURAK, JAMIE LYN III (PA-C)
Entity type:Individual
Prefix:MS
First Name:JAMIE
Middle Name:LYN
Last Name:MACURAK
Suffix:III
Gender:F
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 1:3471 5TH AVE
Mailing Address - Street 2:1010 KAUFMANN BUILDING
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213-3215
Mailing Address - Country:US
Mailing Address - Phone:412-687-3900
Mailing Address - Fax:
Practice Address - Street 1:3471 5TH AVE
Practice Address - Street 2:1010 KAUFMANN BUILDING
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-3215
Practice Address - Country:US
Practice Address - Phone:412-687-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA000821363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP81496Medicare UPIN