Healthcare Provider Details

I. General information

NPI: 1811198146
Provider Name (Legal Business Name): JOHN DMOCHOWSKI, MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 08/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 TEATICKET HWY SUITE 1B
TEATICKET MA
02536-5671
US

IV. Provider business mailing address

270 TEATICKET HWY SUITE 1B
TEATICKET MA
02536-5671
US

V. Phone/Fax

Practice location:
  • Phone: 508-548-8626
  • Fax: 508-548-0260
Mailing address:
  • Phone: 508-548-8626
  • Fax: 508-548-0260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number39343
License Number StateMA

VIII. Authorized Official

Name: JOHN F DMOCHOWSKI
Title or Position: OWNER
Credential: M.D.
Phone: 508-548-8626