Healthcare Provider Details

I. General information

NPI: 1043477946
Provider Name (Legal Business Name): JOHN M GORLOWSKI MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2008
Last Update Date: 05/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

761 JOHNSONBURG RD SUITE 360
SAINT MARYS PA
15857-3483
US

IV. Provider business mailing address

761 JOHNSONBURG RD SUITE 360
SAINT MARYS PA
15857-3483
US

V. Phone/Fax

Practice location:
  • Phone: 814-781-8677
  • Fax:
Mailing address:
  • Phone: 814-781-8677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberMD056208L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number39D0909674
License Number StatePA

VIII. Authorized Official

Name: JOHN M GORLOWSKI
Title or Position: OWNER
Credential: MD
Phone: 814-781-8677