Provider Demographics
NPI:1962478404
Name:DACHOWSKI, EDWARD ALBERT JR (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:ALBERT
Last Name:DACHOWSKI
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:90 JACKSON PIKE
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-1562
Mailing Address - Country:US
Mailing Address - Phone:740-446-5387
Mailing Address - Fax:740-446-5387
Practice Address - Street 1:100 JACKSON PIKE
Practice Address - Street 2:
Practice Address - City:GALLIPOLIS
Practice Address - State:OH
Practice Address - Zip Code:45631-1560
Practice Address - Country:US
Practice Address - Phone:740-446-5000
Practice Address - Fax:740-446-5317
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV218002084P0800X
OH350759572084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2167060Medicaid
P00292069OtherRR MEDICARE
000000315703OtherANTHEM BCBS
OH2167060OtherMOLINA MEDICAID
OH000000185250OtherUNISON MEDICAID
WV1810653000Medicaid
OH310917085121OtherCARESOURCE MEDICAID
OH310917085121OtherCARESOURCE MEDICAID
WV1810653000Medicaid