Provider Demographics
NPI:1255601555
Name:MOCHAN, EUGENE (DO)
Entity type:Individual
Prefix:
First Name:EUGENE
Middle Name:
Last Name:MOCHAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4170 CITY AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19131-1610
Mailing Address - Country:US
Mailing Address - Phone:484-682-8109
Mailing Address - Fax:215-871-6781
Practice Address - Street 1:4170 CITY AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19131-1610
Practice Address - Country:US
Practice Address - Phone:484-682-8109
Practice Address - Fax:215-871-6781
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-04
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS004002L208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice