Provider Demographics
NPI:1306964218
Name:GOSZKOWSKI, PAUL HENRY (DC)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:HENRY
Last Name:GOSZKOWSKI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1124 S CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21230-4240
Mailing Address - Country:US
Mailing Address - Phone:410-332-0044
Mailing Address - Fax:410-332-0097
Practice Address - Street 1:1124 S CHARLES ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21230-4240
Practice Address - Country:US
Practice Address - Phone:410-332-0044
Practice Address - Fax:410-332-0097
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS01248111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDS01248OtherLICENSE