Provider Demographics
NPI:1447243696
Name:CZARNECKI, NANCY S (MD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:S
Last Name:CZARNECKI
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 1:9410 ACADEMY RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19114-2624
Mailing Address - Country:US
Mailing Address - Phone:215-934-7947
Mailing Address - Fax:
Practice Address - Street 1:920B HARVEST DR
Practice Address - Street 2:1ST FLOOR
Practice Address - City:BLUE BELL
Practice Address - State:PA
Practice Address - Zip Code:19422-1900
Practice Address - Country:US
Practice Address - Phone:215-775-5435
Practice Address - Fax:215-775-5440
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD008721E207Q00000X
NJ25MA07177100207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAN17188Medicare ID - Type Unspecified