Provider Demographics
NPI:1174580070
Name:DUDZINSKI, JOHN ERIC (DO)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ERIC
Last Name:DUDZINSKI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:115 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORTH EAST
Mailing Address - State:PA
Mailing Address - Zip Code:16428-1330
Mailing Address - Country:US
Mailing Address - Phone:814-725-8774
Mailing Address - Fax:814-725-2391
Practice Address - Street 1:115 E MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTH EAST
Practice Address - State:PA
Practice Address - Zip Code:16428-1330
Practice Address - Country:US
Practice Address - Phone:814-725-8774
Practice Address - Fax:814-725-2391
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PABD1063407207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010944130002Medicaid
PAB40543Medicare UPIN
PA0010944130002Medicaid