Provider Demographics
NPI:1679659809
Name:UPDIKE, JOHN (PAC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:UPDIKE
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:239 EAST BROWN STREET
Mailing Address - Street 2:MEDICAL ASSOCIATES OF MONROE COUNTY
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301
Mailing Address - Country:US
Mailing Address - Phone:570-421-3872
Mailing Address - Fax:570-424-6631
Practice Address - Street 1:239 EAST BROWN STREET
Practice Address - Street 2:MEDICAL ASSOCIATES OF MONROE COUNTY
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301
Practice Address - Country:US
Practice Address - Phone:570-421-3872
Practice Address - Fax:570-424-6631
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA000193L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
S00287Medicare UPIN
003867ECNMedicare ID - Type UnspecifiedGROUP
34383Medicare ID - Type Unspecified