Provider Demographics
NPI:1073565065
Name:DACHOWSKI, ALICE A (MD)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:A
Last Name:DACHOWSKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ALICE
Other - Middle Name:A
Other - Last Name:GRICOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:90 JACKSON PIKE
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-1560
Mailing Address - Country:US
Mailing Address - Phone:740-446-5225
Mailing Address - Fax:740-446-5956
Practice Address - Street 1:100 JACKSON PIKE
Practice Address - Street 2:
Practice Address - City:GALLIPOLIS
Practice Address - State:OH
Practice Address - Zip Code:45631-1560
Practice Address - Country:US
Practice Address - Phone:855-446-5937
Practice Address - Fax:740-446-5956
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV15255208600000X
OH35-05-3018208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
001714046OtherMOUNTAIN STATE BCBS
WV0124072000Medicaid
OH0631945OtherMOLINA MEDICAID
OH000000181428OtherUNISON MEDICAID
000000006551OtherANTHEM BCBS
020017725OtherRR MEDICARE
OH310917085089OtherCARESOURCE MEDICAID
020017725OtherRR MEDICARE
WV0124072000Medicaid
000000006551OtherANTHEM BCBS