Provider Demographics
NPI:1699985986
Name:MUCHNOK, TIMOTHY KENNETH (DO)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:KENNETH
Last Name:MUCHNOK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 SANDRA LN
Mailing Address - Street 2:
Mailing Address - City:CHESWICK
Mailing Address - State:PA
Mailing Address - Zip Code:15024-4016
Mailing Address - Country:US
Mailing Address - Phone:412-477-5222
Mailing Address - Fax:
Practice Address - Street 1:4535 DRESSLER RD NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-2545
Practice Address - Country:US
Practice Address - Phone:330-493-4443
Practice Address - Fax:330-493-8677
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS014698207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102306352Medicaid
PA102306352Medicaid
WV3810024572Medicare PIN