Provider Demographics
NPI:1477658235
Name:KOWALEWSKI, MARCI ANN (PAC)
Entity type:Individual
Prefix:MS
First Name:MARCI
Middle Name:ANN
Last Name:KOWALEWSKI
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:512 HILLSIDE STREET
Mailing Address - Street 2:
Mailing Address - City:RICHMONDALE
Mailing Address - State:PA
Mailing Address - Zip Code:18421
Mailing Address - Country:US
Mailing Address - Phone:570-785-9373
Mailing Address - Fax:
Practice Address - Street 1:263 CARBONDALE RD
Practice Address - Street 2:BOX Z
Practice Address - City:WAYMART
Practice Address - State:PA
Practice Address - Zip Code:18472
Practice Address - Country:US
Practice Address - Phone:570-488-5444
Practice Address - Fax:570-488-6666
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PA0A000262L363A00000X
PAMA001229L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
534836Medicare UPIN