Provider Demographics
NPI:1811198146
Name:JOHN DMOCHOWSKI, MD PC
Entity type:Organization
Organization Name:JOHN DMOCHOWSKI, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:F
Authorized Official - Last Name:DMOCHOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-548-8626
Mailing Address - Street 1:270 TEATICKET HWY
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:TEATICKET
Mailing Address - State:MA
Mailing Address - Zip Code:02536-5671
Mailing Address - Country:US
Mailing Address - Phone:508-548-8626
Mailing Address - Fax:508-548-0260
Practice Address - Street 1:270 TEATICKET HWY
Practice Address - Street 2:SUITE 1B
Practice Address - City:TEATICKET
Practice Address - State:MA
Practice Address - Zip Code:02536-5671
Practice Address - Country:US
Practice Address - Phone:508-548-8626
Practice Address - Fax:508-548-0260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA39343174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA14915000OtherMAGELLAN
MA713643OtherTUFTS
MAL 02012OtherBLUE CROSS BLUE SHIELD
MAA 59722Medicare UPIN
MAL 02012OtherBLUE CROSS BLUE SHIELD