Basic Information
| Provider Information | |||||||||
| NPI: | 1104820687 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FOCKLER | ||||||||
| FirstName: | CRAIG | ||||||||
| MiddleName: | H | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 321 MAIN ST STE 3D | ||||||||
| Address2: | |||||||||
| City: | JOHNSTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 159011632 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8145357576 | ||||||||
| FaxNumber: | 8145361369 | ||||||||
| Practice Location | |||||||||
| Address1: | 241 SCHOOLHOUSE RD STE 201 | ||||||||
| Address2: | |||||||||
| City: | JOHNSTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 159043239 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8142665650 | ||||||||
| FaxNumber: | 8142665653 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2005 | ||||||||
| LastUpdateDate: | 12/23/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | OS009255L | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 001600760 | 05 | PA | MEDICAID |