Provider Demographics
NPI:1205841665
Name:NIEWIADOMSKI, SLAWOMIR TADEUSZ (MD)
Entity Type:Individual
Prefix:
First Name:SLAWOMIR
Middle Name:TADEUSZ
Last Name:NIEWIADOMSKI
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Gender:M
Credentials:MD
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Mailing Address - Street 1:7592 METROPOLITAN DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-4428
Mailing Address - Country:US
Mailing Address - Phone:619-325-8726
Mailing Address - Fax:619-325-8728
Practice Address - Street 1:7592 METROPOLITAN DR
Practice Address - Street 2:SUITE 405-407
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-4428
Practice Address - Country:US
Practice Address - Phone:619-297-4900
Practice Address - Fax:619-297-5460
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2008-06-20
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Provider Licenses
StateLicense IDTaxonomies
CAA50674207ZC0500X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A506740Medicaid
CA220026527Medicare PIN
CAG36605Medicare UPIN
CAWA50674AMedicare PIN
CA00A506740Medicaid
CAWA50674BMedicare PIN