Provider Demographics
NPI:1366894982
Name:PRAVAK & ASSOCIATES PC
Entity type:Organization
Organization Name:PRAVAK & ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED REP/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROMAN
Authorized Official - Middle Name:OREST
Authorized Official - Last Name:PRAVAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:484-526-3010
Mailing Address - Street 1:800 OSTRUM ST STE 100
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN HILL
Mailing Address - State:PA
Mailing Address - Zip Code:18015-1010
Mailing Address - Country:US
Mailing Address - Phone:484-526-3010
Mailing Address - Fax:484-526-3591
Practice Address - Street 1:800 OSTRUM ST STE 100
Practice Address - Street 2:
Practice Address - City:FOUNTAIN HILL
Practice Address - State:PA
Practice Address - Zip Code:18015-1010
Practice Address - Country:US
Practice Address - Phone:484-526-3010
Practice Address - Fax:484-526-3591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA207WX0107X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina SpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103150256-0001Medicaid
PA150723Medicare PIN
PA103150256-0001Medicaid
PA530671Medicare PIN