Provider Demographics
NPI:1992700553
Name:DMOCHOWSKA, HANNA (MD)
Entity type:Individual
Prefix:
First Name:HANNA
Middle Name:
Last Name:DMOCHOWSKA
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 1:4500 PINE AVE
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16504-2316
Mailing Address - Country:US
Mailing Address - Phone:814-877-5800
Mailing Address - Fax:814-877-5809
Practice Address - Street 1:4500 PINE AVE
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16504-2316
Practice Address - Country:US
Practice Address - Phone:814-877-5800
Practice Address - Fax:814-877-5809
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD053791L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA205112OtherUPMC
OH2224471OtherOH MEDICAL ASSISTANCE
PA0015442120007Medicaid
NY00026080501OtherUNIVERA
NY02149315OtherNY MEDICAL ASSISTANCE
PA789965OtherBLUE SHIELD
PA65273OtherUNISON
PAP000092OtherGATEWAY
PA080187044OtherRR MEDICARE
PA3119426OtherAETNA
NY02149315OtherNY MEDICAL ASSISTANCE
PA789965E7CMedicare PIN