Provider Demographics
NPI:1285632497
Name:KOWALSKI, JOHN P (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:P
Last Name:KOWALSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2660 NEW MARKET RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23231-7408
Mailing Address - Country:US
Mailing Address - Phone:804-795-1144
Mailing Address - Fax:804-795-1052
Practice Address - Street 1:2660 NEW MARKET RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23231-7408
Practice Address - Country:US
Practice Address - Phone:804-795-1144
Practice Address - Fax:804-795-1052
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-12
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101034330207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5634253Medicaid
VA080002099Medicare ID - Type Unspecified
VA5634253Medicaid