Individual
DR. FOTIS G MYSTAKAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
912 RUSSELL DR, LEBANON, PA 17042-7485
(717) 272-7971
(717) 272-1241
Mailing address
3421 CONCORD RD, YORK, PA 17402-9001
(717) 272-7971
(717) 272-1241
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
MD034196L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000643495
—
PA
01
—
127119
MEDICARE
PA
Enumeration date
02/27/2006
Last updated
03/18/2016
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