MEDICARE: NICHOLAS J GORSKI DO

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	207Q00000X	Family Medicine Physician	OS022275	PA

General Provider Information

NPI Number	:	1609339167
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS J GORSKI DO

Provider Business Mailing Address
First Line	:	1201 GRAMPIAN BLVD
Second Line	:
City	:	WILLIAMSPORT
State	:	PA
Zip	:	17701-1900
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2370 OLD TURNPIKE RD STE 1
Second Line	:
City	:	LEWISBURG
State	:	PA
Zip	:	17837-6567
Country	:	US
Telephone Number	:	570-551-0191
Fax Number	:	570-522-9387

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

Provider Enumeration Date	:	04/11/2019
Last Update Date	:	07/14/2023

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