Provider Demographics
NPI:1134114036
Name:POGORELEC, EUGENE D
Entity Type:Individual
Prefix:
First Name:EUGENE
Middle Name:D
Last Name:POGORELEC
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3515 MASSILLON RD STE 300
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44685-7854
Mailing Address - Country:US
Mailing Address - Phone:330-899-9350
Mailing Address - Fax:330-634-1329
Practice Address - Street 1:2300 WALES AVE NW STE 100
Practice Address - Street 2:
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646-2323
Practice Address - Country:US
Practice Address - Phone:330-832-3188
Practice Address - Fax:330-634-1329
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-002769-P207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0395246Medicaid
OHPO0463541Medicare ID - Type Unspecified
OH0395246Medicaid