Healthcare Provider Details

I. General information

NPI: 1164407581
Provider Name (Legal Business Name): JOHN OGRODNICK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2005
Last Update Date: 05/31/2023
Certification Date: 05/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 STATION CIR
HAZLE TOWNSHIP PA
18202-9726
US

IV. Provider business mailing address

2100 MACK BLVD FL 4
ALLENTOWN PA
18103-5622
US

V. Phone/Fax

Practice location:
  • Phone: 570-501-6800
  • Fax:
Mailing address:
  • Phone: 570-790-2391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberCO33580
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberMD479832
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: