Provider Demographics
NPI:1295795656
Name:PACYNA, GARY A (DPM)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:A
Last Name:PACYNA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:921 DRINKER TPKE STE 21
Mailing Address - Street 2:
Mailing Address - City:COVINGTON TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:18444-7948
Mailing Address - Country:US
Mailing Address - Phone:570-842-0400
Mailing Address - Fax:570-842-1449
Practice Address - Street 1:921 DRINKER TPKE STE 21
Practice Address - Street 2:
Practice Address - City:COVINGTON TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:18444-7948
Practice Address - Country:US
Practice Address - Phone:570-842-0400
Practice Address - Fax:570-842-1449
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-27
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC003408L213ER0200X, 213ES0000X, 213ES0131X, 213E00000X
PA0649380001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
No213ER0200XPodiatric Medicine & Surgery Service ProvidersPodiatristRadiology
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0211163000OtherBC PERSONAL CHOICE
NJ8193207OtherUNISYS
PA30263 5822OtherGEISINGER GOLD
PA073911OtherBLUE SHIELD HMO
PA476121OtherFIRST PRIORITY FOR LIFE
PA74559OtherMED PLUS
PA0649380001Medicaid
PA0575152OtherAETNA
PA480012183OtherRAILROAD MEDICARE
PA2Y8325OtherPHS
PA30263 5822OtherGEISINGER HEALTH PLAN
PA0575152OtherAETNA
PA30263 5822OtherGEISINGER HEALTH PLAN
PA0211163000OtherBC PERSONAL CHOICE