Provider Demographics
NPI:1255391157
Name:GAWLAS, MICHAEL RAYMOND (DO)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:RAYMOND
Last Name:GAWLAS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:612 S MARKET ST
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17055-6416
Mailing Address - Country:US
Mailing Address - Phone:717-805-7569
Mailing Address - Fax:717-240-1905
Practice Address - Street 1:1000 CLAREMONT ROAD
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17013
Practice Address - Country:US
Practice Address - Phone:717-240-1916
Practice Address - Fax:717-240-1905
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOS005058L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA429794Medicare PIN
B41672Medicare UPIN