Provider Demographics
NPI:1467631150
Name:PAWLOWSKI, THOMAS E
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:E
Last Name:PAWLOWSKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5310 LAKE PADDOCK CIRCLE
Mailing Address - Street 2:
Mailing Address - City:PARRISH
Mailing Address - State:FL
Mailing Address - Zip Code:34219
Mailing Address - Country:US
Mailing Address - Phone:941-212-2131
Mailing Address - Fax:
Practice Address - Street 1:385 BEAUMONT HWY
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:CT
Practice Address - Zip Code:06249-1146
Practice Address - Country:US
Practice Address - Phone:860-456-1669
Practice Address - Fax:860-456-3543
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-30
Last Update Date:2017-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004125698Medicaid
CT3971790001Medicare NSC