Provider Demographics
NPI:1669666947
Name:JOHN DMOCHOWSKI, MD PC
Entity Type:Organization
Organization Name:JOHN DMOCHOWSKI, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:F
Authorized Official - Last Name:DMOCHOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD PC
Authorized Official - Phone:508-548-8626
Mailing Address - Street 1:31 MELTIAH RD
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02540-1843
Mailing Address - Country:US
Mailing Address - Phone:508-548-8626
Mailing Address - Fax:508-548-0260
Practice Address - Street 1:31 MELTIAH RD
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02540-1843
Practice Address - Country:US
Practice Address - Phone:508-548-8626
Practice Address - Fax:508-548-0260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-30
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA393432084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction PsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAL02012OtherBLUE CROSS BLUE SHEILD
MA688215OtherTUFTS
MA688215OtherTUFTS