Provider Demographics
NPI:1831542885
Name:PIERWOLA, KACPER KRZYSZTOF (MD)
Entity type:Individual
Prefix:
First Name:KACPER
Middle Name:KRZYSZTOF
Last Name:PIERWOLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:675 GOOD DR
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-2426
Mailing Address - Country:US
Mailing Address - Phone:717-406-3000
Mailing Address - Fax:717-394-7501
Practice Address - Street 1:675 GOOD DR
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-2426
Practice Address - Country:US
Practice Address - Phone:717-406-3000
Practice Address - Fax:717-394-7501
Is Sole Proprietor?:No
Enumeration Date:2016-07-14
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PAMD474945208100000X, 2081P0301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P0301XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationBrain Injury Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation