Provider Demographics
NPI:1376548594
Name:CHAWLUK, JOHN B (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:B
Last Name:CHAWLUK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:48 TUNNEL RD
Mailing Address - Street 2:STE 101
Mailing Address - City:POTTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17901-3875
Mailing Address - Country:US
Mailing Address - Phone:570-622-2245
Mailing Address - Fax:570-622-2116
Practice Address - Street 1:48 TUNNEL RD
Practice Address - Street 2:STE 101
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901-3875
Practice Address - Country:US
Practice Address - Phone:570-622-2245
Practice Address - Fax:570-622-2116
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-15
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD025204E2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA02337500OtherCAPITAL BLUE CROSS
PA02337500OtherKEYSTONE HEALTH PLAN
PAC33219OtherHEALTHAMERICA
PAJC193412OtherHIGHMARK BLUE SHIELD
PA2650964OtherAETNA HEALTHCARE
PAC33219OtherHEALTHAMERICA
PAJC193412OtherHIGHMARK BLUE SHIELD