Provider Demographics
NPI:1306900865
Name:MAKSIMIK, CRYSTAL (DO)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:MAKSIMIK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 PARAMOUNT BLVD
Mailing Address - Street 2:
Mailing Address - City:ORWIGSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17961-2202
Mailing Address - Country:US
Mailing Address - Phone:272-639-1000
Mailing Address - Fax:
Practice Address - Street 1:100 PARAMOUNT BLVD
Practice Address - Street 2:
Practice Address - City:ORWIGSBURG
Practice Address - State:PA
Practice Address - Zip Code:17961
Practice Address - Country:US
Practice Address - Phone:272-639-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS013642207RC0000X
PAOT010538207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101805124Medicaid