Organization
FAIRFIELD AVE FAMILY PRACTICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CAROL ELIZABETH KOWTONIUK D.O. (VICE PRESIDENT)
(814) 535-6167
Entity
Organization
Contact information
Practice address
226 FAIRFIELD AVE, JOHNSTOWN, PA 15906-2310
(814) 535-6167
Mailing address
226 FAIRFIELD AVE, JOHNSTOWN, PA 15906-2310
(814) 535-6167
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1007300380005
—
PA
Enumeration date
05/08/2007
Last updated
03/03/2016
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