Provider Demographics
NPI:1285614263
Name:BAZYLAK, ROBERT A (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:A
Last Name:BAZYLAK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:12387 CONNEAUT LAKE RD
Mailing Address - Street 2:
Mailing Address - City:CONNEAUT LAKE
Mailing Address - State:PA
Mailing Address - Zip Code:16316-4203
Mailing Address - Country:US
Mailing Address - Phone:814-382-0221
Mailing Address - Fax:814-382-0231
Practice Address - Street 1:1034 GROVE ST
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-2945
Practice Address - Country:US
Practice Address - Phone:814-373-4233
Practice Address - Fax:814-724-2196
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2017-01-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD014601E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
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PAP00303284OtherPALMETTO GBA-RAILROAD MEDICARE
PA251754199019OtherMEDICAL MUTUAL OF OHIO
PAB40196OtherHEALTH AMERICA
PA157308OtherHIGHMARK BLUE CROSS BLUE SHIELD
PA251754199019OtherMEDICAL MUTUAL OF OHIO
PAB40196OtherHEALTH AMERICA