Provider Demographics
NPI:1578608204
Name:GAWCHIK, SANDRA M (DO)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:M
Last Name:GAWCHIK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 CHERRY STREET
Mailing Address - Street 2:RIVERS EDGE 12C
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103
Mailing Address - Country:US
Mailing Address - Phone:610-733-4162
Mailing Address - Fax:
Practice Address - Street 1:1 PRESIDENTS DRIVE
Practice Address - Street 2:PRESIDENTS HOUSE CCMC
Practice Address - City:UPLAND
Practice Address - State:PA
Practice Address - Zip Code:19013
Practice Address - Country:US
Practice Address - Phone:610-876-1249
Practice Address - Fax:610-876-2101
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOS003029L207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B34357Medicare UPIN
048867G6HMedicare ID - Type Unspecified