Provider Demographics
NPI:1609867118
Name:POHODICH, EDWARD J (CRNP)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:J
Last Name:POHODICH
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2616 MEMORIAL BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:CONNELLSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15425-1418
Mailing Address - Country:US
Mailing Address - Phone:724-628-9350
Mailing Address - Fax:724-628-9353
Practice Address - Street 1:2616 MEMORIAL BLVD STE B
Practice Address - Street 2:
Practice Address - City:CONNELLSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15425-1418
Practice Address - Country:US
Practice Address - Phone:724-628-9350
Practice Address - Fax:724-628-9353
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP007926363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA074242SL3OtherMEDICARE NUMBER
PA074242SL3OtherMEDICARE NUMBER