Provider Demographics
NPI:1366699084
Name:ZOLTACK, TODD MICHAEL (PA-C)
Entity type:Individual
Prefix:MR
First Name:TODD
Middle Name:MICHAEL
Last Name:ZOLTACK
Suffix:
Gender:M
Credentials:PA-C
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Other - First Name:
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Mailing Address - Street 1:3760 BROOKSIDE RD
Mailing Address - Street 2:PO BOX 487
Mailing Address - City:MACUNGIE
Mailing Address - State:PA
Mailing Address - Zip Code:18062-1741
Mailing Address - Country:US
Mailing Address - Phone:610-966-4646
Mailing Address - Fax:610-965-6201
Practice Address - Street 1:3760 BROOKSIDE RD
Practice Address - Street 2:
Practice Address - City:MACUNGIE
Practice Address - State:PA
Practice Address - Zip Code:18062-1741
Practice Address - Country:US
Practice Address - Phone:610-966-4646
Practice Address - Fax:610-965-6201
Is Sole Proprietor?:No
Enumeration Date:2008-08-25
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOA002271363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical