Provider Demographics
NPI:1558476648
Name:KIRKOWSKI, JOHN JOSEPH (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:JOSEPH
Last Name:KIRKOWSKI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 GUTHRIE SQ
Mailing Address - Street 2:
Mailing Address - City:SAYRE
Mailing Address - State:PA
Mailing Address - Zip Code:18840-1625
Mailing Address - Country:US
Mailing Address - Phone:570-888-5858
Mailing Address - Fax:
Practice Address - Street 1:127 SULLIVAN ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:PA
Practice Address - Zip Code:17724-1733
Practice Address - Country:US
Practice Address - Phone:570-673-3197
Practice Address - Fax:570-673-8297
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS003118L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101235309Medicaid
P00200492Medicare ID - Type UnspecifiedRR MEDICARE #
PA171748MY1Medicare ID - Type UnspecifiedINDIVIDUAL MEDICARE #
PA101235309Medicaid