Provider Demographics
NPI:1346207883
Name:OSSOWSKI, MACIEJ GERARD (M D)
Entity Type:Individual
Prefix:DR
First Name:MACIEJ
Middle Name:GERARD
Last Name:OSSOWSKI
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:3349 G ST STE D
Mailing Address - Street 2:SUITE D
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340-0978
Mailing Address - Country:US
Mailing Address - Phone:209-722-8040
Mailing Address - Fax:209-722-0287
Practice Address - Street 1:3349 G ST STE D
Practice Address - Street 2:SUITE D
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-0978
Practice Address - Country:US
Practice Address - Phone:209-722-8040
Practice Address - Fax:209-722-0287
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA00A383800207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1740575182OtherNPI
FA688AMedicare PIN
CA1740575182OtherNPI