Provider Demographics
NPI:1922219724
Name:GAUTHIER, AGNIESZKA EWA (MD)
Entity type:Individual
Prefix:DR
First Name:AGNIESZKA
Middle Name:EWA
Last Name:GAUTHIER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1469 MONTICELLO AVE
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:PA
Mailing Address - Zip Code:16148-4445
Mailing Address - Country:US
Mailing Address - Phone:248-229-2654
Mailing Address - Fax:
Practice Address - Street 1:94 W CONNELLY BLVD
Practice Address - Street 2:SHARON COMMUNITY HEALTH CENTER
Practice Address - City:SHARON
Practice Address - State:PA
Practice Address - Zip Code:16146-1754
Practice Address - Country:US
Practice Address - Phone:724-347-2429
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4406232084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry