Provider Demographics
NPI:1053448498
Name:KADZIELSKI, JOHN J (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:J
Last Name:KADZIELSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2 POND PARK RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:HINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02043-4347
Mailing Address - Country:US
Mailing Address - Phone:781-337-5555
Mailing Address - Fax:
Practice Address - Street 1:2 POND PARK RD
Practice Address - Street 2:SUITE 102
Practice Address - City:HINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02043-4347
Practice Address - Country:US
Practice Address - Phone:781-337-5555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAL-228167207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110088698AMedicaid
1053448498OtherBLUE CROSS BLUE SHIELD
479451OtherTUFTS