Healthcare Provider Details

I. General information

NPI: 1902836612
Provider Name (Legal Business Name): CATHERINE CHODKIEWICZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 08/11/2025
Certification Date: 08/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 MULBERRY ST
SCRANTON PA
18510-2369
US

IV. Provider business mailing address

100 N ACADEMY AVE
DANVILLE PA
17822-9403
US

V. Phone/Fax

Practice location:
  • Phone: 570-703-8000
  • Fax: 570-703-8002
Mailing address:
  • Phone: 570-703-8000
  • Fax: 570-703-8002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberMD424139
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier271430200
Identifier TypeMEDICAID
Identifier StateFL
Identifier Issuer
# 2
Identifier50126
Identifier TypeOTHER
Identifier StateFL
Identifier IssuerBLUE CROSS BLUE SHIELD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: