Provider Demographics
NPI:1942238977
Name:HOCHBERG, HENRY (MD)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:
Last Name:HOCHBERG
Suffix:
Gender:M
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:PO BOX 1119
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98020-1119
Mailing Address - Country:US
Mailing Address - Phone:425-771-0184
Mailing Address - Fax:425-771-0674
Practice Address - Street 1:22721 76TH AVE W
Practice Address - Street 2:#B
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-3000
Practice Address - Country:US
Practice Address - Phone:425-672-2427
Practice Address - Fax:425-672-9172
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA0025343207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA005682OtherLABOR AND INDUSTRIES
WA1062975Medicaid
080022415OtherRAILROAD MEDICARE
WAG001201315Medicare PIN
001201315Medicare ID - Type Unspecified
080022415OtherRAILROAD MEDICARE