Provider Demographics
NPI:1043748122
Name:PRISHCHEPOVA, ANNA (MD)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:PRISHCHEPOVA
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 1:232 W 25TH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16544-0002
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:204 W 26TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16508-1806
Practice Address - Country:US
Practice Address - Phone:814-864-4755
Practice Address - Fax:814-864-5430
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-01
Last Update Date:2023-09-20
Deactivation Date:2018-01-05
Deactivation Code:
Reactivation Date:2018-02-02
Provider Licenses
StateLicense IDTaxonomies
MO2020019626207R00000X, 207RC0200X, 390200000X
PAMD479612207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program