Healthcare Provider Details

I. General information

NPI: 1538325105
Provider Name (Legal Business Name): JOSEPH ANTHONY GWISZCZ JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2008
Last Update Date: 07/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 HAVERFORD ROAD. SUITE 100
HAVERFORD PA
19041
US

IV. Provider business mailing address

600 HAVERFORD ROAD. SUITE 100
HAVERFORD PA
19041
US

V. Phone/Fax

Practice location:
  • Phone: 610-658-0999
  • Fax:
Mailing address:
  • Phone: 610-658-0999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD442428
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: