Provider Demographics
NPI:1902803257
Name:JANICKA, IWONA JOANNA (MD)
Entity type:Individual
Prefix:
First Name:IWONA
Middle Name:JOANNA
Last Name:JANICKA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 MEMORY LN
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-2231
Mailing Address - Country:US
Mailing Address - Phone:717-851-1405
Mailing Address - Fax:
Practice Address - Street 1:112 N 7TH ST
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-1720
Practice Address - Country:US
Practice Address - Phone:717-217-4300
Practice Address - Fax:717-217-4217
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD064990L207QH0002X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50074295OtherCAPITAL BLUECROSS
PAP00683486OtherRAILROAD MEDICARE
PA001722083 0003Medicaid
PAP002561OtherGATEWAY
PA31822OtherHIGHMARK BLUE SHIELD
PAMD064990LOtherLICENSE
PAPEARLOtherHEALTH AMERICA
PABJ5887813OtherDEA
PA25-1716306OtherHEALTHNET/TRICARE
PA280080OtherUNISON (GI)
PAP002561OtherGATEWAY
PAPEARLOtherHEALTH AMERICA
PA867633OtherMEDICARE GROUP #
PAP00683486OtherRAILROAD MEDICARE
PA2134311OtherAETNA HMO
PA25-1716306OtherGREATWEST
PAMD064990LOtherLICENSE
PA25-1716306OtherDEVON
PA225857OtherUNISON (WH)
PA25-1716306OtherINFORMED
PA25-1716306OtherSOUTH CENTRAL PREFERRED
PA25-1716306OtherINTERGROUP
PAG920-0073/25RXCUOtherCAREFIRST
PA001722083 0003Medicaid
PAPEARLOtherHEALTH AMERICA
PA280080OtherUNISON (GI)