Provider Demographics
NPI:1144294588
Name:DROZDIAK, RUSSELL (MD)
Entity type:Individual
Prefix:
First Name:RUSSELL
Middle Name:
Last Name:DROZDIAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:349 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:CLYMER
Mailing Address - State:PA
Mailing Address - Zip Code:15728-1173
Mailing Address - Country:US
Mailing Address - Phone:724-254-4314
Mailing Address - Fax:724-254-2350
Practice Address - Street 1:349 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:CLYMER
Practice Address - State:PA
Practice Address - Zip Code:15728-1173
Practice Address - Country:US
Practice Address - Phone:724-254-4314
Practice Address - Fax:724-254-2350
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD027632E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009460810002Medicaid
PA0009460810002Medicaid
PA028787Medicare PIN