Healthcare Provider Details

I. General information

NPI: 1356134787
Provider Name (Legal Business Name): PATRICK KOWALSKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2025
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3509 N BROAD ST STE 226
PHILADELPHIA PA
19140-4105
US

IV. Provider business mailing address

2043 CAROL ANN WAY
BETHLEHEM PA
18015-5508
US

V. Phone/Fax

Practice location:
  • Phone: 610-984-4429
  • Fax:
Mailing address:
  • Phone: 610-984-4429
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMT234227
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: