Provider Demographics
NPI:1467637991
Name:CZERNIAKOW, MARCIN WILHELM (MD)
Entity Type:Individual
Prefix:
First Name:MARCIN
Middle Name:WILHELM
Last Name:CZERNIAKOW
Suffix:
Gender:M
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:PO BOX 708850
Mailing Address - Street 2:SANDY
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-8850
Mailing Address - Country:US
Mailing Address - Phone:866-869-2395
Mailing Address - Fax:801-352-9502
Practice Address - Street 1:2430 W PIERCE ST
Practice Address - Street 2:CARLSBAD
Practice Address - City:CARLSBAD
Practice Address - State:NM
Practice Address - Zip Code:88220-3553
Practice Address - Country:US
Practice Address - Phone:505-887-4321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-03
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2007-0734207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine