Healthcare Provider Details

I. General information

NPI: 1043748122
Provider Name (Legal Business Name): ANNA PRISHCHEPOVA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2017
Last Update Date: 09/20/2023
Certification Date: 09/20/2023
Deactivation Date: 01/05/2018
Reactivation Date: 02/02/2018

III. Provider practice location address

204 W 26TH ST
ERIE PA
16508-1806
US

IV. Provider business mailing address

232 W 25TH ST
ERIE PA
16544-0002
US

V. Phone/Fax

Practice location:
  • Phone: 814-864-4755
  • Fax: 814-864-5430
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2020019626
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number2020019626
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number2020019626
License Number StateMO
# 4
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberMD479612
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: