Healthcare Provider Details

I. General information

NPI: 1033116553
Provider Name (Legal Business Name): EDWARD GORALCZYK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 05/24/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 SCENERY DR
ELIZABETH PA
15037-2068
US

IV. Provider business mailing address

300 SCENERY DR
ELIZABETH PA
15037-2068
US

V. Phone/Fax

Practice location:
  • Phone: 412-751-4661
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD021045E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: