Provider Demographics
NPI:1467436006
Name:SZCZYGIEL, GERARD W (DO)
Entity Type:Individual
Prefix:DR
First Name:GERARD
Middle Name:W
Last Name:SZCZYGIEL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67-1123 MAMALAHOA HWY.
Mailing Address - Street 2:
Mailing Address - City:KAMUELA
Mailing Address - State:HI
Mailing Address - Zip Code:96743
Mailing Address - Country:US
Mailing Address - Phone:808-885-9606
Mailing Address - Fax:808-885-9506
Practice Address - Street 1:67-1123 MAMALAHOA HWY
Practice Address - Street 2:
Practice Address - City:KAMUELA
Practice Address - State:HI
Practice Address - Zip Code:96743-8451
Practice Address - Country:US
Practice Address - Phone:808-885-9606
Practice Address - Fax:808-885-9506
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-06
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1931207V00000X
AK5884207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD81232Medicaid
WV1808404000Medicaid
AKK161241Medicare PIN
WV1808404000Medicaid
AKMD81232Medicaid