Provider Demographics
NPI:1023011640
Name:GOTKIEWICZ, DAWN-MARIE
Entity Type:Individual
Prefix:
First Name:DAWN-MARIE
Middle Name:
Last Name:GOTKIEWICZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11279 PERRY HWY
Mailing Address - Street 2:STE 450
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-9303
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:159 WATERDAM RD
Practice Address - Street 2:STE 220
Practice Address - City:MC MURRAY
Practice Address - State:PA
Practice Address - Zip Code:15317-2576
Practice Address - Country:US
Practice Address - Phone:724-969-6970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD060202L208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAG82684Medicare UPIN