Provider Demographics
NPI:1225017429
Name:CIESIELSKI, PAULA F (MD)
Entity Type:Individual
Prefix:DR
First Name:PAULA
Middle Name:F
Last Name:CIESIELSKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 N 16TH ST
Mailing Address - Street 2:SUITE 303
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-4175
Mailing Address - Country:US
Mailing Address - Phone:541-746-6815
Mailing Address - Fax:541-726-3177
Practice Address - Street 1:960 N 16TH ST
Practice Address - Street 2:SUITE 303
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-4175
Practice Address - Country:US
Practice Address - Phone:541-746-6815
Practice Address - Fax:541-726-3177
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD12953207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR229278Medicaid
OR131160Medicare ID - Type Unspecified
OR229278Medicaid