Provider Demographics
NPI:1033211727
Name:HATALOWICH, GREGORY S (DPM)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:S
Last Name:HATALOWICH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:YOUNGWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:15697-1306
Mailing Address - Country:US
Mailing Address - Phone:724-925-6360
Mailing Address - Fax:724-925-6360
Practice Address - Street 1:12 N 4TH ST
Practice Address - Street 2:
Practice Address - City:YOUNGWOOD
Practice Address - State:PA
Practice Address - Zip Code:15697-1306
Practice Address - Country:US
Practice Address - Phone:724-925-6360
Practice Address - Fax:724-925-6360
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC0002440L213E00000X, 213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA104091Medicare ID - Type Unspecified
PA104091Medicare PIN
PAT28642Medicare UPIN