Provider Demographics
NPI:1780625590
Name:GAJDOWSKI, RICHARD JAN (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:JAN
Last Name:GAJDOWSKI
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 1:110 MERLIN DR
Mailing Address - Street 2:
Mailing Address - City:MC MURRAY
Mailing Address - State:PA
Mailing Address - Zip Code:15317-3330
Mailing Address - Country:US
Mailing Address - Phone:412-587-5093
Mailing Address - Fax:412-587-5091
Practice Address - Street 1:110 MERLIN DR
Practice Address - Street 2:
Practice Address - City:MC MURRAY
Practice Address - State:PA
Practice Address - Zip Code:15317-3330
Practice Address - Country:US
Practice Address - Phone:412-587-5093
Practice Address - Fax:412-587-5091
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-10
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35066568207P00000X
PAMD047759L207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0127651Medicaid
OH0127651Medicaid
OHGA0779314Medicare PIN