Provider Demographics
NPI:1194761015
Name:OCKRYMIEK, DOUGLAS A (DO)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:A
Last Name:OCKRYMIEK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:MOUNTVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17554-1232
Mailing Address - Country:US
Mailing Address - Phone:717-285-7121
Mailing Address - Fax:717-285-5302
Practice Address - Street 1:790 NEW HOLLAND AVE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602-2137
Practice Address - Country:US
Practice Address - Phone:717-390-0353
Practice Address - Fax:717-390-1812
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS004324L2084P0800X, 2084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2095770OtherCIGNA BEHAV HEALTH
PA115435OtherPA BLUE SHIELD
PA000957497Medicaid
PA50052373OtherCAPITAL BLUE CROSS
PA115435OtherPA BLUE SHIELD
PA115435Medicare ID - Type Unspecified