Provider Demographics
NPI:1932160223
Name:JOHN B. CHAWLUK, MD, PC
Entity Type:Organization
Organization Name:JOHN B. CHAWLUK, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:A
Authorized Official - Last Name:PIEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-622-2245
Mailing Address - Street 1:48 TUNNEL RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:POTTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17901-3875
Mailing Address - Country:US
Mailing Address - Phone:570-622-2245
Mailing Address - Fax:
Practice Address - Street 1:48 TUNNEL RD
Practice Address - Street 2:SUITE 101
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901-3875
Practice Address - Country:US
Practice Address - Phone:570-622-2245
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-28
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1324194OtherHIGHMARK NUMBER
PA0010149690012Medicaid
PA02337500OtherCAPITAL BLUE CROSS
PA0010149690012Medicaid