Provider Demographics
NPI:1760406177
Name:OLSZOWSKA, AGATA KATARZYNA (MD)
Entity Type:Individual
Prefix:DR
First Name:AGATA
Middle Name:KATARZYNA
Last Name:OLSZOWSKA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:AGATA
Other - Middle Name:KATARZYNA
Other - Last Name:ZGLESZEWSKI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:932 HASTINGS RD
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:NY
Mailing Address - Zip Code:14456-9135
Mailing Address - Country:US
Mailing Address - Phone:419-706-1497
Mailing Address - Fax:315-787-4973
Practice Address - Street 1:367 E MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:NY
Practice Address - Zip Code:13165-1643
Practice Address - Country:US
Practice Address - Phone:315-787-4977
Practice Address - Fax:315-787-4973
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY255097207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH34170154302OtherBUREAU OF WORKERS COMPENS
080181051OtherRAILROAD MEDICARE
OH2261609Medicaid
OH000000205442OtherANTHEM BC/BS
080181051OtherRAILROAD MEDICARE
OH2261609Medicaid