Provider Demographics
NPI:1073624441
Name:NIEWIAROWSKI, TOMASZ J (MD)
Entity Type:Individual
Prefix:
First Name:TOMASZ
Middle Name:J
Last Name:NIEWIAROWSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 S NEW ST STE 201
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18015-1112
Mailing Address - Country:US
Mailing Address - Phone:610-866-0113
Mailing Address - Fax:610-974-8589
Practice Address - Street 1:306 S NEW ST STE 201
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18015-1652
Practice Address - Country:US
Practice Address - Phone:610-866-0113
Practice Address - Fax:610-974-8589
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD040218L207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA123855OtherMEDICARE PTAN
PA0012930600003Medicaid
PA0012930600003Medicaid
PA123855Medicare PIN
PAF25864Medicare UPIN