Provider Demographics
NPI:1740425099
Name:CHISTAKOFF, GEORGE J (PA-C)
Entity type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:J
Last Name:CHISTAKOFF
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:101 W BERN ST
Mailing Address - Street 2:HSC BLDG 22
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19601
Mailing Address - Country:US
Mailing Address - Phone:610-208-2276
Mailing Address - Fax:610-208-2748
Practice Address - Street 1:101 W BERN ST
Practice Address - Street 2:HSC BLDG 22
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19601
Practice Address - Country:US
Practice Address - Phone:610-208-2276
Practice Address - Fax:610-208-2748
Is Sole Proprietor?:No
Enumeration Date:2008-12-15
Last Update Date:2009-01-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMA003540L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant