Provider Demographics
NPI:1083604797
Name:RADECKI, PAUL D (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:D
Last Name:RADECKI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:9910 FRANKLIN SQUARE DR
Mailing Address - Street 2:# 2110
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21236-4902
Mailing Address - Country:US
Mailing Address - Phone:706-653-1102
Mailing Address - Fax:706-653-1230
Practice Address - Street 1:1145 19TH ST NW
Practice Address - Street 2:SUITE 205
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-3701
Practice Address - Country:US
Practice Address - Phone:301-279-4499
Practice Address - Fax:301-279-4489
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2017-02-21
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Provider Licenses
StateLicense IDTaxonomies
MDD00463182085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
164781G23Medicare ID - Type Unspecified
B40455Medicare UPIN