Provider Demographics
NPI:1730220682
Name:SLYWKA, MARK S (DO)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:S
Last Name:SLYWKA
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 1:928 OLD LOGGER RD
Mailing Address - Street 2:
Mailing Address - City:MOSCOW
Mailing Address - State:PA
Mailing Address - Zip Code:18444-8614
Mailing Address - Country:US
Mailing Address - Phone:570-842-3426
Mailing Address - Fax:
Practice Address - Street 1:423 SCRANTON CARBONDALE HWY
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18508-1115
Practice Address - Country:US
Practice Address - Phone:570-558-6372
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS012416207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
138149OtherMEDPLUS
3605884OtherAETNA
815489OtherFIRST PRIORITY HEALTH
G45293Medicare UPIN
PA064475Medicare PIN
815489OtherFIRST PRIORITY HEALTH