Provider Demographics
NPI:1285867457
Name:WITOLD CZERWINSKI, MD PA
Entity Type:Organization
Organization Name:WITOLD CZERWINSKI, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WITOLD
Authorized Official - Middle Name:PAWEL
Authorized Official - Last Name:CZERWINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:870-793-2800
Mailing Address - Street 1:PO BOX 3951
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72503-3951
Mailing Address - Country:US
Mailing Address - Phone:870-793-2800
Mailing Address - Fax:870-793-2862
Practice Address - Street 1:12 HOSPITAL CIR
Practice Address - Street 2:SUITE B
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-7310
Practice Address - Country:US
Practice Address - Phone:870-793-2800
Practice Address - Fax:870-793-2862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-03
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE26232084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
E2623OtherLICENSE
H27714Medicare UPIN
E2623OtherLICENSE