Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 211993 | MA |
NPI | 1053308353 |
---|---|
Provider Name | Dr. Magdalena Czerkawska-Zydzik |
First Address | Springfield, MA 01104-2301 |
Second Address | Springfield, MA 01104-2301 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2005 |
Last Update Date | 11/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0157040 | (05) | MA |
H53141 | (02) |