Provider Demographics
NPI:1154316909
Name:JAMIOLKOWSKI, MARIA S (DO)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:S
Last Name:JAMIOLKOWSKI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 938
Mailing Address - Street 2:945 BETHESDA DR SUITE 110
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43702-0938
Mailing Address - Country:US
Mailing Address - Phone:740-450-4271
Mailing Address - Fax:740-450-4286
Practice Address - Street 1:945 BETHESDA DR
Practice Address - Street 2:SUITE 110
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-0801
Practice Address - Country:US
Practice Address - Phone:740-450-4271
Practice Address - Fax:740-450-4286
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-19
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34007115J207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2127200Medicaid
OH2127200Medicaid
4016321Medicare ID - Type Unspecified