Provider Demographics
NPI:1124009188
Name:BOJEWSKI, BRYANT E (DO)
Entity Type:Individual
Prefix:
First Name:BRYANT
Middle Name:E
Last Name:BOJEWSKI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 LECOM PL
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16505-2571
Mailing Address - Country:US
Mailing Address - Phone:814-868-2507
Mailing Address - Fax:814-868-2522
Practice Address - Street 1:2820 W 12TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16505-4204
Practice Address - Country:US
Practice Address - Phone:814-833-8800
Practice Address - Fax:814-833-2079
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-08
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS006966L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011701770001Medicaid
E30060Medicare UPIN
566192Medicare ID - Type Unspecified