Provider Demographics
NPI:1407805328
Name:DOROCIAK, JEFFERY JOSEPH (MD PHD)
Entity Type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:JOSEPH
Last Name:DOROCIAK
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:571 SAINT JOSEPHS BLVD
Mailing Address - Street 2:FL 2
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14901-3230
Mailing Address - Country:US
Mailing Address - Phone:607-271-2050
Mailing Address - Fax:607-271-2099
Practice Address - Street 1:46 FAIRVIEW AVE STE 221
Practice Address - Street 2:
Practice Address - City:SKOWHEGAN
Practice Address - State:ME
Practice Address - Zip Code:04976-1481
Practice Address - Country:US
Practice Address - Phone:207-474-6945
Practice Address - Fax:207-474-6933
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC14495174400000X
NY294166207RG0100X
OH35.141191207RG0100X
MEMD22232207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1407805328Medicaid
SC144953Medicaid
SCF54340Medicare UPIN