Provider Demographics
NPI:1093946071
Name:LUTWIN-KAWALEC, MALGORZATA S (MD)
Entity Type:Individual
Prefix:
First Name:MALGORZATA
Middle Name:S
Last Name:LUTWIN-KAWALEC
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MALGORZATA
Other - Middle Name:S
Other - Last Name:LUTWIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 191
Mailing Address - Street 2:PROVIDER ENROLLMENT
Mailing Address - City:ROCKLAND
Mailing Address - State:DE
Mailing Address - Zip Code:19732-0191
Mailing Address - Country:US
Mailing Address - Phone:302-651-6212
Mailing Address - Fax:302-651-4945
Practice Address - Street 1:1600 ROCKLAND ROAD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-3607
Practice Address - Country:US
Practice Address - Phone:302-651-4200
Practice Address - Fax:302-651-5365
Is Sole Proprietor?:No
Enumeration Date:2009-08-07
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08554500174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJMA08554500OtherSTATE LICENSE