Provider Demographics
NPI:1912043357
Name:DRAGICH, JACK M
Entity type:Individual
Prefix:MR
First Name:JACK
Middle Name:M
Last Name:DRAGICH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:523 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15017-2043
Mailing Address - Country:US
Mailing Address - Phone:412-221-2788
Mailing Address - Fax:412-221-2119
Practice Address - Street 1:523 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:BRIDGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15017-2043
Practice Address - Country:US
Practice Address - Phone:412-221-2788
Practice Address - Fax:412-221-2119
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAF02985237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist