Provider Demographics
NPI:1487747366
Name:ROCKWELL, MARK J (PA-C)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:J
Last Name:ROCKWELL
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
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Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4903
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:570-271-6578
Practice Address - Street 1:560 MCELHATTAN DR.
Practice Address - Street 2:
Practice Address - City:LOCK HAVEN
Practice Address - State:PA
Practice Address - Zip Code:17748
Practice Address - Country:US
Practice Address - Phone:570-263-4042
Practice Address - Fax:570-769-5022
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2020-08-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMA052757363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0107664OtherHIGHMARK
PAQ75884Medicare UPIN
PA107664Medicare PIN