Provider Demographics
NPI:1790765352
Name:MERGLOWSKI, TIMOTHY (PA)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:MERGLOWSKI
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:343 E ROY FURMAN HWY
Mailing Address - Street 2:
Mailing Address - City:WAYNESBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15370-8084
Mailing Address - Country:US
Mailing Address - Phone:724-627-8080
Mailing Address - Fax:724-852-7510
Practice Address - Street 1:343 E ROY FURMAN HWY
Practice Address - Street 2:
Practice Address - City:WAYNESBURG
Practice Address - State:PA
Practice Address - Zip Code:15370-8084
Practice Address - Country:US
Practice Address - Phone:724-627-8080
Practice Address - Fax:724-852-7510
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA002586L363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
S50222Medicare UPIN
047748Medicare ID - Type Unspecified