Basic Information
| Provider Information | |||||||||
| NPI: | 1225042971 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PAWLOWSKI | ||||||||
| FirstName: | NICHOLAS | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 E PENN SQ | ||||||||
| Address2: | 9TH FLOOR | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191073323 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2674259258 | ||||||||
| FaxNumber: | 2674259299 | ||||||||
| Practice Location | |||||||||
| Address1: | 3550 MARKET ST FL 3 | ||||||||
| Address2: | CHILDREN'S HOSPITAL OF PHILADELPHIA - ALLERGY & IMMUN | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191043365 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2155902549 | ||||||||
| FaxNumber: | 2155904529 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2006 | ||||||||
| LastUpdateDate: | 10/24/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207K00000X | MD036736E | PA | N | Allopathic & Osteopathic Physicians | Allergy & Immunology | 207RA0201X | MD036736E | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Allergy & Immunology | 208000000X | MD036736E | PA | N | Allopathic & Osteopathic Physicians | Pediatrics | 2080P0201X | MD036736E | PA | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Allergy/Immunology | 207K00000X | 25MA06129700 | NJ | N | Allopathic & Osteopathic Physicians | Allergy & Immunology | 207RA0201X | 25MA06129700 | NJ | N | Allopathic & Osteopathic Physicians | Internal Medicine | Allergy & Immunology | 208000000X | 25MA06129700 | NJ | N | Allopathic & Osteopathic Physicians | Pediatrics | 2080P0201X | 25MA06129700 | NJ | N | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Allergy/Immunology |
ID Information
| ID | Type | State | Issuer | Description | 1652508 | 05 | NJ | MEDICAID | 001060489 | 05 | PA | MEDICAID |