Provider Demographics
NPI:1457356511
Name:GULCZYNSKI, COLLEEN (DO)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:GULCZYNSKI
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 1:41 UNIVERSITY DR STE 300
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-1873
Mailing Address - Country:US
Mailing Address - Phone:215-710-5522
Mailing Address - Fax:215-710-5181
Practice Address - Street 1:2510 MARYLAND RD
Practice Address - Street 2:SUITE 160
Practice Address - City:WILLOW GROVE
Practice Address - State:PA
Practice Address - Zip Code:19090-1109
Practice Address - Country:US
Practice Address - Phone:215-672-6622
Practice Address - Fax:215-672-6566
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOS010396L208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
I02112Medicare UPIN