MEDICARE: EDWARD GOTKIEWICZ MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	MD053822L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598768202
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDWARD GOTKIEWICZ MD

Provider Business Mailing Address
First Line	:	11279 PERRY HWY
Second Line	:	STE 450
City	:	WEXFORD
State	:	PA
Zip	:	15090-9303
Country	:	US
Telephone Number	:	724-933-1100
Fax Number	:	724-933-1160

Provider Business Practice Location Address
First Line	:	603 WASHINGTON RD
Second Line	:	STE 300
City	:	PITTSBURGH
State	:	PA
Zip	:	15228-1928
Country	:	US
Telephone Number	:	412-563-6151
Fax Number	:	412-344-3780

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	07/08/2007

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Directions to “ EDWARD GOTKIEWICZ MD” Practice Location

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