Individual
DR. HEATH MATTHEW YANICKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O
Contact information
Practice address
965 SHAMROCK LN, CORRY, PA 16407-9121
(814) 664-4641
(814) 664-7967
Mailing address
1 LECOM PL, ERIE, PA 16505-2571
(814) 868-2522
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
OT014991
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1030614320003
—
PA
Enumeration date
02/26/2013
Last updated
01/05/2017
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