Provider Demographics
NPI:1740274729
Name:GORLOWSKI, JOHN MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:MICHAEL
Last Name:GORLOWSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:761 JOHNSONBURG RD
Mailing Address - Street 2:SUITE 360
Mailing Address - City:ST MARYS
Mailing Address - State:PA
Mailing Address - Zip Code:15857-3483
Mailing Address - Country:US
Mailing Address - Phone:814-781-8677
Mailing Address - Fax:814-781-8246
Practice Address - Street 1:761 JOHNSONBURG RD
Practice Address - Street 2:SUITE 360
Practice Address - City:ST MARYS
Practice Address - State:PA
Practice Address - Zip Code:15857-3483
Practice Address - Country:US
Practice Address - Phone:814-781-8677
Practice Address - Fax:814-781-8246
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-07
Last Update Date:2008-04-23
Deactivation Date:2006-03-24
Deactivation Code:
Reactivation Date:2006-03-30
Provider Licenses
StateLicense IDTaxonomies
PAMD056208-L2080A0000X
PA024093291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
No291U00000XLaboratoriesClinical Medical Laboratory