Provider Demographics
NPI:1619287299
Name:JAN BACHOWSKI, MD
Entity Type:Organization
Organization Name:JAN BACHOWSKI, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BACHOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-881-5585
Mailing Address - Street 1:11125 ROCKVILLE PIKE
Mailing Address - Street 2:#104
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-3142
Mailing Address - Country:US
Mailing Address - Phone:301-881-5585
Mailing Address - Fax:301-881-5579
Practice Address - Street 1:11125 ROCKVILLE PIKE
Practice Address - Street 2:#104
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-3142
Practice Address - Country:US
Practice Address - Phone:301-881-5585
Practice Address - Fax:301-881-5579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-15
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0035370174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDE13405Medicare UPIN