Provider Demographics
NPI:1518044239
Name:DZIEDZIC-WISINSKI, WIESLAWA D (MD)
Entity Type:Individual
Prefix:MRS
First Name:WIESLAWA
Middle Name:D
Last Name:DZIEDZIC-WISINSKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:WIESLAWA
Other - Middle Name:D
Other - Last Name:WISINSKI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:8114 SANDPIPER CIRCLE
Mailing Address - Street 2:#100
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21236
Mailing Address - Country:US
Mailing Address - Phone:410-933-8101
Mailing Address - Fax:410-933-8106
Practice Address - Street 1:8114 SANDPIPER CIRCLE
Practice Address - Street 2:#100
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21236
Practice Address - Country:US
Practice Address - Phone:410-933-8101
Practice Address - Fax:410-933-8106
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0043818208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD146581300Medicaid
089L394UMedicare ID - Type Unspecified
MD146581300Medicaid