Provider Demographics
NPI:1740575182
Name:MACIEJ G. OSSOWSKI, M.D., INC.
Entity Type:Organization
Organization Name:MACIEJ G. OSSOWSKI, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MACIEJ
Authorized Official - Middle Name:GERARD
Authorized Official - Last Name:OSSOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-722-8040
Mailing Address - Street 1:3349 G ST STE D
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340-0978
Mailing Address - Country:US
Mailing Address - Phone:209-722-8040
Mailing Address - Fax:209-722-0287
Practice Address - Street 1:3349 G ST STE D
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-0978
Practice Address - Country:US
Practice Address - Phone:209-722-8040
Practice Address - Fax:209-722-0287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-14
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA38380207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1346207883OtherNPI
FA693ZMedicare PIN
CA1346207883OtherNPI
CAA28603Medicare UPIN