Individual
MRS. ELENA I FOMCHENKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD, PHD
Contact information
Practice address
2315 MYRTLE ST STE L90, ERIE, PA 16502-4607
(814) 452-7575
Mailing address
2315 MYRTLE ST STE L90, ERIE, PA 16502-4607
(814) 452-7575
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
MD481326
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
15956049
CAQH
—
Enumeration date
05/06/2013
Last updated
08/01/2023
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