Provider Demographics
NPI:1144369869
Name:KOWTONIUK, CAROL E (DO)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:E
Last Name:KOWTONIUK
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 1:226 FAIRFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15906-2310
Mailing Address - Country:US
Mailing Address - Phone:814-535-6167
Mailing Address - Fax:814-535-5428
Practice Address - Street 1:226 FAIRFIELD AVE
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15906-2310
Practice Address - Country:US
Practice Address - Phone:814-535-6167
Practice Address - Fax:814-535-5428
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS004976L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAOS004976LMedicaid
PAOS004976LMedicaid
043634Medicare ID - Type Unspecified