Basic Information
| Provider Information | |||||||||
| NPI: | 1558413492 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SACHAROK | ||||||||
| FirstName: | CYNTHIA | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 MACDADE BLVD | ||||||||
| Address2: | |||||||||
| City: | MILMONT PARK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190333311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6106197300 | ||||||||
| FaxNumber: | 6105220445 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 MACDADE BLVD | ||||||||
| Address2: | |||||||||
| City: | MILMONT PARK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19033 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6106197300 | ||||||||
| FaxNumber: | 6105220445 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2007 | ||||||||
| LastUpdateDate: | 07/08/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD043214L | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 011229775 | 05 | PA | MEDICAID |