Healthcare Provider Details

I. General information

NPI: 1447082482
Provider Name (Legal Business Name): JOSHUA MICHAEL PAVLOVICH PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2024
Last Update Date: 10/23/2024
Certification Date: 10/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

322 PARK AVE
DUNKIRK NY
14048-2237
US

IV. Provider business mailing address

4115 RIDGEFIELD TER
HAMBURG NY
14075-6437
US

V. Phone/Fax

Practice location:
  • Phone: 716-366-7150
  • Fax:
Mailing address:
  • Phone: 716-531-6888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number032690-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: