Provider Demographics
NPI:1457458168
Name:KOWALYK, STEPHAN (MD)
Entity Type:Individual
Prefix:
First Name:STEPHAN
Middle Name:
Last Name:KOWALYK
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 1:540 SOUTH ST
Mailing Address - Street 2:SUITE 306
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-2774
Mailing Address - Country:US
Mailing Address - Phone:724-832-3130
Mailing Address - Fax:724-832-7301
Practice Address - Street 1:540 SOUTH ST
Practice Address - Street 2:SUITE 306
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-2774
Practice Address - Country:US
Practice Address - Phone:724-832-3130
Practice Address - Fax:724-832-7301
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD052412L207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0014688720001Medicaid
PA0014688720001Medicaid
PAE86549Medicare UPIN