Provider Demographics
NPI:1174517585
Name:DRELICK, RICHARD F (PA-C)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:F
Last Name:DRELICK
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 PROSPECT AVE
Mailing Address - Street 2:SUITE 12
Mailing Address - City:FRANKLIN
Mailing Address - State:PA
Mailing Address - Zip Code:16323-2542
Mailing Address - Country:US
Mailing Address - Phone:814-437-6188
Mailing Address - Fax:814-432-7663
Practice Address - Street 1:150 PROSPECT AVE
Practice Address - Street 2:SUITE 12
Practice Address - City:FRANKLIN
Practice Address - State:PA
Practice Address - Zip Code:16323-2542
Practice Address - Country:US
Practice Address - Phone:814-437-6188
Practice Address - Fax:814-432-7663
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA000010L363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAR05976Medicare UPIN
PA083703Medicare ID - Type Unspecified