Provider Demographics
NPI:1003012832
Name:JOHN M. GORLOWSKI, M.D.
Entity Type:Organization
Organization Name:JOHN M. GORLOWSKI, M.D.
Other - Org Name:JOHN M. GORLOWSKI MD LAB
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:GORLOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-781-8677
Mailing Address - Street 1:761 JOHNSONBURG RD
Mailing Address - Street 2:SUITE 360
Mailing Address - City:SAINT MARYS
Mailing Address - State:PA
Mailing Address - Zip Code:15857-3483
Mailing Address - Country:US
Mailing Address - Phone:814-781-8677
Mailing Address - Fax:814-781-8246
Practice Address - Street 1:761 JOHNSONBURG RD
Practice Address - Street 2:SUITE 360
Practice Address - City:SAINT MARYS
Practice Address - State:PA
Practice Address - Zip Code:15857-3483
Practice Address - Country:US
Practice Address - Phone:814-781-8677
Practice Address - Fax:814-781-8246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA024093291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAG17298Medicare UPIN