Provider Demographics
NPI:1073900270
Name:GRZADZIEL, JOANNA (DO)
Entity Type:Individual
Prefix:DR
First Name:JOANNA
Middle Name:
Last Name:GRZADZIEL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 S CENTRE AVE STE A3
Mailing Address - Street 2:
Mailing Address - City:LEESPORT
Mailing Address - State:PA
Mailing Address - Zip Code:19533-8661
Mailing Address - Country:US
Mailing Address - Phone:610-926-5707
Mailing Address - Fax:610-926-8352
Practice Address - Street 1:5 S CENTRE AVE STE A3
Practice Address - Street 2:
Practice Address - City:LEESPORT
Practice Address - State:PA
Practice Address - Zip Code:19533-8661
Practice Address - Country:US
Practice Address - Phone:610-926-5707
Practice Address - Fax:610-926-8352
Is Sole Proprietor?:No
Enumeration Date:2015-04-25
Last Update Date:2020-12-04
Deactivation Date:2016-09-14
Deactivation Code:
Reactivation Date:2017-05-01
Provider Licenses
StateLicense IDTaxonomies
PAOS020821207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine