Healthcare Provider Details

I. General information

NPI: 1760643605
Provider Name (Legal Business Name): JOHN PAUL GNIADY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2008
Last Update Date: 06/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 UNIVERSITY DR
HERSHEY PA
17033-2360
US

IV. Provider business mailing address

1901 FLOYD ST
SARASOTA FL
34239-2932
US

V. Phone/Fax

Practice location:
  • Phone: 800-243-1455
  • Fax: 717-531-4907
Mailing address:
  • Phone: 941-366-9222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberMD466854
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: