Basic Information
| Provider Information | |||||||||
| NPI: | 1346310984 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GARCIA | ||||||||
| FirstName: | MAGDIEL | ||||||||
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| Credential: | CRNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 225 ERDMAN ST | ||||||||
| Address2: | |||||||||
| City: | BANGOR | ||||||||
| State: | PA | ||||||||
| PostalCode: | 180132043 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6105882225 | ||||||||
| FaxNumber: | 6105882292 | ||||||||
| Practice Location | |||||||||
| Address1: | 225 ERDMAN ST | ||||||||
| Address2: | |||||||||
| City: | BANGOR | ||||||||
| State: | PA | ||||||||
| PostalCode: | 180132043 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6105882225 | ||||||||
| FaxNumber: | 6105882292 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2006 | ||||||||
| LastUpdateDate: | 09/17/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | SP012758 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | P38305 | 01 | PA | AMERIHEALTH | OTHER | 50033226 | 01 | PA | CAPITAL BLUE CROSS | OTHER | 660979 | 01 | PA | UNITED HEALTHCARE | OTHER | 2795062 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER |