Provider Demographics
NPI:1235110107
Name:CZARNECKI, ALICIA ANN (MD)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:ANN
Last Name:CZARNECKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:ANN
Other - Last Name:KROL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:9 HOPE AVE
Mailing Address - Street 2:SUITE 151
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453
Mailing Address - Country:US
Mailing Address - Phone:781-788-8444
Mailing Address - Fax:781-893-1273
Practice Address - Street 1:9 HOPE AVE
Practice Address - Street 2:SUITE 151
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453
Practice Address - Country:US
Practice Address - Phone:781-788-8444
Practice Address - Fax:781-893-1273
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA224071207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2105012Medicaid
I37485Medicare UPIN
A38947Medicare ID - Type Unspecified