Basic Information
| Provider Information | |||||||||
| NPI: | 1356360085 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ZELECHOSKI | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | MARK | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 HOSPITAL DR | ||||||||
| Address2: | SUITE 306 | ||||||||
| City: | LEWISBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 178379350 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5705224110 | ||||||||
| FaxNumber: | 5707683911 | ||||||||
| Practice Location | |||||||||
| Address1: | 7055 WESTBRANCH HWY | ||||||||
| Address2: | |||||||||
| City: | LEWISBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 178376808 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5705244141 | ||||||||
| FaxNumber: | 5705245218 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2006 | ||||||||
| LastUpdateDate: | 05/20/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/20/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | MD039218E | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RE0101X | MD039218E | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism | 207R00000X | MD039218E | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 10754 | 01 | PA | BLUE SHIELD | OTHER | 254363H | 01 | PA | GEISINGER | OTHER | 50000874 | 01 | PA | CAPITAL BLUE CROSS | OTHER | 50000874 | 01 | PA | KEYSTONE | OTHER | E12823 | 01 | PA | HEALTH AMERICA | OTHER | 118438710 | 01 | PA | DEPARTMENT OF LABOR | OTHER | 232809429 | 01 | PA | TRICARE | OTHER | P00139424 | 01 | PA | RAILROAD MEDICARE | OTHER | 0011546380004 | 05 | PA | MEDICAID | 20011512 | 01 | PA | AMERIHEALTH | OTHER |