Provider Demographics
NPI:1487827663
Name:MLYNARCZYK, MALGORZATA AGNIESZKA (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:MALGORZATA
Middle Name:AGNIESZKA
Last Name:MLYNARCZYK
Suffix:
Gender:F
Credentials:MD, PHD
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Mailing Address - Street 1:PO BOX 936
Mailing Address - Street 2:EVMS MEDICAL GROUP
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23501-0936
Mailing Address - Country:US
Mailing Address - Phone:757-446-7900
Mailing Address - Fax:757-446-7464
Practice Address - Street 1:825 FAIRFAX AVE
Practice Address - Street 2:SUITE 310
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1914
Practice Address - Country:US
Practice Address - Phone:757-446-7900
Practice Address - Fax:757-446-7464
Is Sole Proprietor?:No
Enumeration Date:2008-04-08
Last Update Date:2015-07-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101251615207VM0101X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1487827663OtherAETNA
VA-010OtherTRICARE
VA1487827663OtherVIRGINIA PREMIER HEALTH PLAN
VA1487827663OtherUSA MANAGED CARE
VA1487827663OtherVIRGINIA HEALTH NETWORK
VA1487827663OtherCOVENTRY NETWORK
VA1487827663OtherCORVEL
VA1487827663OtherMULTIPLAN
NC1487827663Medicaid
VA10147772OtherOPTIMA HEALTH
VA1487827663OtherANTHEM BC/BS
VA1487827663Medicaid
VA-010OtherTRICARE