Provider Demographics
NPI:1508843616
Name:GOWATY, JOSEPH P (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:P
Last Name:GOWATY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4117 PLANK RD
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-4888
Mailing Address - Country:US
Mailing Address - Phone:540-785-8018
Mailing Address - Fax:888-398-9051
Practice Address - Street 1:4117 PLANK RD
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-4888
Practice Address - Country:US
Practice Address - Phone:540-785-8018
Practice Address - Fax:888-398-9051
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110002228363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
4330530001OtherDMERC
VA1508843616Medicare PIN