Provider Demographics
NPI:1477766202
Name:TIMOTHY M BARCZAK MD LLC
Entity Type:Organization
Organization Name:TIMOTHY M BARCZAK MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:M
Authorized Official - Last Name:BARCZAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-444-6711
Mailing Address - Street 1:345 MONTAUK AVE
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:CT
Mailing Address - Zip Code:06320-4738
Mailing Address - Country:US
Mailing Address - Phone:860-444-6711
Mailing Address - Fax:860-437-0650
Practice Address - Street 1:345 MONTAUK AVE
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320-4738
Practice Address - Country:US
Practice Address - Phone:860-444-6711
Practice Address - Fax:860-437-0650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT024666207VG0400X
CT000368363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTB83613Medicare UPIN
CTS47007Medicare UPIN