Provider Demographics
NPI:1346218104
Name:PRAWDZIK, LEOCADIA T (MD)
Entity Type:Individual
Prefix:
First Name:LEOCADIA
Middle Name:T
Last Name:PRAWDZIK
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 1:1090 N CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:HAZLETON
Mailing Address - State:PA
Mailing Address - Zip Code:18202-1446
Mailing Address - Country:US
Mailing Address - Phone:570-459-1485
Mailing Address - Fax:570-459-6354
Practice Address - Street 1:1090 N CHURCH ST
Practice Address - Street 2:
Practice Address - City:HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18202-1446
Practice Address - Country:US
Practice Address - Phone:570-459-1485
Practice Address - Fax:570-459-6354
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD039665L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA435009Medicare ID - Type Unspecified
B41774Medicare UPIN