Healthcare Provider Details

I. General information

NPI: 1457458168
Provider Name (Legal Business Name): STEPHAN KOWALYK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2006
Last Update Date: 01/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 SOUTH ST SUITE 306
GREENSBURG PA
15601-2774
US

IV. Provider business mailing address

540 SOUTH ST SUITE 306
GREENSBURG PA
15601-2774
US

V. Phone/Fax

Practice location:
  • Phone: 724-832-3130
  • Fax: 724-832-7301
Mailing address:
  • Phone: 724-832-3130
  • Fax: 724-832-7301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberMD052412L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: