Provider Demographics
NPI:1518022896
Name:SZCZESNY, LORRAINE B (MD)
Entity Type:Individual
Prefix:DR
First Name:LORRAINE
Middle Name:B
Last Name:SZCZESNY
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 1:24 S 1100 E
Mailing Address - Street 2:SUITE 304
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-1500
Mailing Address - Country:US
Mailing Address - Phone:801-521-4500
Mailing Address - Fax:801-359-1665
Practice Address - Street 1:24 S 1100 E
Practice Address - Street 2:SUITE 304
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-1500
Practice Address - Country:US
Practice Address - Phone:801-521-4500
Practice Address - Fax:801-359-1665
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT86174872207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000012166Medicare ID - Type Unspecified
UTD07848Medicare UPIN