Healthcare Provider Details

I. General information

NPI: 1073565065
Provider Name (Legal Business Name): ALICE A. DACHOWSKI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALICE A. GRICOWSKI M.D.

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 01/21/2021
Certification Date: 01/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 JACKSON PIKE
GALLIPOLIS OH
45631-1560
US

IV. Provider business mailing address

90 JACKSON PIKE
GALLIPOLIS OH
45631-1560
US

V. Phone/Fax

Practice location:
  • Phone: 855-446-5937
  • Fax: 740-446-5956
Mailing address:
  • Phone: 740-446-5225
  • Fax: 740-446-5956

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number15255
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number35-05-3018
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: