Provider Demographics
NPI:1124011044
Name:BULCZAK, DARIUSZ PIOTR (MD)
Entity Type:Individual
Prefix:
First Name:DARIUSZ
Middle Name:PIOTR
Last Name:BULCZAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 NORTH ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4903
Mailing Address - Country:US
Mailing Address - Phone:570-808-7779
Mailing Address - Fax:570-808-5390
Practice Address - Street 1:1000 EAST MOUNTAIN BLVD
Practice Address - Street 2:
Practice Address - City:WILKES-BARRE
Practice Address - State:PA
Practice Address - Zip Code:18711-3446
Practice Address - Country:US
Practice Address - Phone:570-808-7779
Practice Address - Fax:570-808-5390
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2204952085R0202X
PAMD4331902085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology