Provider Demographics
NPI:1225195233
Name:MILCHAK, MARK A (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:MILCHAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 EXCELA HEALTH DR STE 203
Mailing Address - Street 2:
Mailing Address - City:LATROBE
Mailing Address - State:PA
Mailing Address - Zip Code:15650-9001
Mailing Address - Country:US
Mailing Address - Phone:724-539-6320
Mailing Address - Fax:724-539-6333
Practice Address - Street 1:100 EXCELA HEALTH DR STE 203
Practice Address - Street 2:
Practice Address - City:LATROBE
Practice Address - State:PA
Practice Address - Zip Code:15650-9001
Practice Address - Country:US
Practice Address - Phone:724-539-6320
Practice Address - Fax:724-539-6333
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2025-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD045519E207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001202600Medicaid
PA001202600Medicaid
PA232152Medicare PIN