Provider Demographics
NPI:1073592374
Name:FECOWYCZ, BOHDAN OREST (MD)
Entity Type:Individual
Prefix:DR
First Name:BOHDAN
Middle Name:OREST
Last Name:FECOWYCZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 HIDDEN LAKES DR NE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484-4146
Mailing Address - Country:US
Mailing Address - Phone:330-856-3216
Mailing Address - Fax:330-841-5858
Practice Address - Street 1:2588 ELM RD NE
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:OH
Practice Address - Zip Code:44410-9298
Practice Address - Country:US
Practice Address - Phone:330-841-5800
Practice Address - Fax:330-841-5858
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35 . 0380822085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0415965Medicaid
OHE98882Medicare UPIN
OHFE0636821Medicare ID - Type Unspecified