Provider Demographics
NPI:1730149063
Name:MURNOCK, MARIA REGINA (PA-C)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:REGINA
Last Name:MURNOCK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:REGINA
Other - Last Name:LACOE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:RR2 BOX 2217
Mailing Address - Street 2:
Mailing Address - City:FACTORYVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18419
Mailing Address - Country:US
Mailing Address - Phone:570-945-3404
Mailing Address - Fax:570-342-3316
Practice Address - Street 1:326 ADAMS AVENUE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18503
Practice Address - Country:US
Practice Address - Phone:570-348-6100
Practice Address - Fax:570-342-3316
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA050653363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
085788ESLMedicare PIN
P91655Medicare UPIN
085788Medicare ID - Type Unspecified