Provider Demographics
NPI:1760558431
Name:KOCJANCIC, JAMES
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:KOCJANCIC
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 1:201 STATE ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16550-0002
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:201 STATE ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16550-0002
Practice Address - Country:US
Practice Address - Phone:814-877-6139
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS009588L207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1068874OtherWEST VIRGINIA WORK COMP
PA1510449OtherGATEWAY
NY00025988201OtherUNIVERA
PA70980OtherUNISON
PA0016697630001Medicaid
NY01732172OtherNY MEDICAL ASSISTANCE
PA930051158OtherRR MEDICARE
OH2228780OtherOH MEDICAL ASSISTANCE
PA212582OtherUPMC
PA2546026OtherAETNA
PA952599OtherBLUE SHIELD
NY00025988201OtherUNIVERA
NY01732172OtherNY MEDICAL ASSISTANCE