Provider Demographics
NPI:1366486151
Name:GASOWSKI, GARY LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:LEE
Last Name:GASOWSKI
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 1:25 CHARLES ST
Mailing Address - Street 2:SUITE 7
Mailing Address - City:HANOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17331-2267
Mailing Address - Country:US
Mailing Address - Phone:717-632-7714
Mailing Address - Fax:717-632-2839
Practice Address - Street 1:25 CHARLES ST
Practice Address - Street 2:SUITE 7
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-2267
Practice Address - Country:US
Practice Address - Phone:717-632-7714
Practice Address - Fax:717-632-2839
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD035143L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD3068OtherCAREFIRST
PA990481OtherKHP CENTRAL
PA0915423Medicaid
PA4459903OtherAETNA
PA8270499OtherCIGNA
MD3068OtherCAREFIRST
PAB35541Medicare UPIN