Provider Demographics
NPI:1851623896
Name:MOCHON, AGNIESZKA EWELINA (MD)
Entity Type:Individual
Prefix:
First Name:AGNIESZKA
Middle Name:EWELINA
Last Name:MOCHON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-738-0167
Mailing Address - Fax:717-291-9634
Practice Address - Street 1:446 N READING RD STE 302
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:PA
Practice Address - Zip Code:17522-9802
Practice Address - Country:US
Practice Address - Phone:717-738-0167
Practice Address - Fax:717-291-9634
Is Sole Proprietor?:No
Enumeration Date:2010-02-01
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT192298207R00000X
PAMD-450073207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102907782Medicaid
PA345071Medicare PIN