Healthcare Provider Details

I. General information

NPI: 1780625590
Provider Name (Legal Business Name): RICHARD JAN GAJDOWSKI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 10/28/2022
Certification Date: 10/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 MERLIN DR
MC MURRAY PA
15317-3330
US

IV. Provider business mailing address

110 MERLIN DR
MC MURRAY PA
15317-3330
US

V. Phone/Fax

Practice location:
  • Phone: 412-587-5093
  • Fax: 412-587-5091
Mailing address:
  • Phone: 412-587-5093
  • Fax: 412-587-5091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number35066568
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD047759L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0127651
Identifier TypeMEDICAID
Identifier StateOH
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: