Provider Demographics
NPI:1194817759
Name:PLOCIENNIK, KRZYSZTOF (MD)
Entity Type:Individual
Prefix:
First Name:KRZYSZTOF
Middle Name:
Last Name:PLOCIENNIK
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 1:59 PAGE HILL RD
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:NH
Mailing Address - Zip Code:03570-3531
Mailing Address - Country:US
Mailing Address - Phone:603-752-2200
Mailing Address - Fax:603-326-5999
Practice Address - Street 1:7 PAGE HILL RD
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:NH
Practice Address - Zip Code:03570-3531
Practice Address - Country:US
Practice Address - Phone:603-752-2200
Practice Address - Fax:603-326-5999
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH14636207V00000X
VT042-0009852207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT00049367OtherBCBS
VT15V305OtherMVP
UT4675801OtherVERMONT MANAGED CARE APEX
VT420001577OtherTRAVELERS MEDICARE
VT0VN2990Medicaid
VT8000477OtherLADIES FIRST
VTVN2290Medicare ID - Type Unspecified
H17056Medicare UPIN
VT15V305OtherMVP