Robert John Mayshock, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

MA002379L Issued in PA

Practice address

1100 Grampian Blvd
Divine Providence Hospital - Ipbh
Williamsport, PA 17701-1909

Phone

(570) 326-8295

NPI assigned

Jan 4, 2012

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1325635200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1325635200000",
    "number": "1295005429",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "181 PLEASANT VIEW EST",
            "city": "TURBOTVILLE",
            "state": "PA",
            "postal_code": "177728655",
            "telephone_number": "570-649-5070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 GRAMPIAN BLVD",
            "address_2": "DIVINE PROVIDENCE HOSPITAL - IPBH",
            "city": "WILLIAMSPORT",
            "state": "PA",
            "postal_code": "177011909",
            "telephone_number": "570-326-8295"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAYSHOCK",
        "first_name": "ROBERT",
        "middle_name": "JOHN",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-01-04",
        "last_updated": "2012-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "PA",
            "license": "MA002379L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Medical Physician Assistant in Williamsport, PA
• Providers in Williamsport, PA by specialty
• Medical Physician Assistant in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.