Provider Demographics
NPI:1801972781
Name:BOJEWSKI, ROMAN E (DO)
Entity type:Individual
Prefix:DR
First Name:ROMAN
Middle Name:E
Last Name:BOJEWSKI
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 1:4108 ZUCK RD
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16506-4539
Mailing Address - Country:US
Mailing Address - Phone:814-877-8600
Mailing Address - Fax:814-877-8602
Practice Address - Street 1:4108 ZUCK RD
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16506-4539
Practice Address - Country:US
Practice Address - Phone:814-877-8600
Practice Address - Fax:814-877-8602
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS004134L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000591245Medicaid
PA000591245Medicaid
PA093246Medicare PIN