Basic Information
| Provider Information | |||||||||
| NPI: | 1174518930 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MACPHAIL | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | ADAM | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 329 S PLEASANT AVE | ||||||||
| Address2: | |||||||||
| City: | SOMERSET | ||||||||
| State: | PA | ||||||||
| PostalCode: | 155012262 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8144453575 | ||||||||
| FaxNumber: | 8144455700 | ||||||||
| Practice Location | |||||||||
| Address1: | 126 E CHURCH ST STE 2100 | ||||||||
| Address2: | |||||||||
| City: | SOMERSET | ||||||||
| State: | PA | ||||||||
| PostalCode: | 155012271 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8144451281 | ||||||||
| FaxNumber: | 8144433214 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2005 | ||||||||
| LastUpdateDate: | 01/17/2018 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | 03/25/2006 | ||||||||
| NPIReactivationDate: | 04/06/2006 | ||||||||
| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 2009-02130 | NC | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | MD021853E | PA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 002982424 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 710929 | 01 | PA | MEDICARE | OTHER | 0015083500032 | 05 | PA | MEDICAID | CI6140 | 01 | PA | RAILROAD MEDICARE | OTHER |