Provider Demographics
NPI:1104906585
Name:KOLARIK, GARY F (DO)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:F
Last Name:KOLARIK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 W 12TH ST
Mailing Address - Street 2:#614
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16505-4527
Mailing Address - Country:US
Mailing Address - Phone:814-452-5579
Mailing Address - Fax:814-452-5099
Practice Address - Street 1:232 W 25TH ST
Practice Address - Street 2:REHAB DEPT
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16544-0002
Practice Address - Country:US
Practice Address - Phone:814-452-5579
Practice Address - Fax:814-452-5099
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOS007178L208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019550200001Medicaid
PA070035Medicare ID - Type Unspecified
PA0019550200001Medicaid