Provider Demographics
NPI:1528321049
Name:MON, PYONE MYAT (MD)
Entity type:Individual
Prefix:
First Name:PYONE MYAT
Middle Name:
Last Name:MON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 ASH ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:DUNMORE
Mailing Address - State:PA
Mailing Address - Zip Code:18509-2907
Mailing Address - Country:US
Mailing Address - Phone:570-344-2244
Mailing Address - Fax:570-344-1226
Practice Address - Street 1:521 ASH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:DUNMORE
Practice Address - State:PA
Practice Address - Zip Code:18509-2907
Practice Address - Country:US
Practice Address - Phone:570-344-2244
Practice Address - Fax:570-344-1226
Is Sole Proprietor?:No
Enumeration Date:2012-06-19
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PAMD455511207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1030443600001Medicaid
PA1030443600001Medicaid