Provider Demographics
NPI:1518958289
Name:KREJCI, NIELS C (MD)
Entity Type:Individual
Prefix:DR
First Name:NIELS
Middle Name:C
Last Name:KREJCI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:95 CHAPEL ST
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-3155
Mailing Address - Country:US
Mailing Address - Phone:781-762-5858
Mailing Address - Fax:781-949-4343
Practice Address - Street 1:128 CARNEGIE ROW
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-5010
Practice Address - Country:US
Practice Address - Phone:781-762-5858
Practice Address - Fax:781-762-3307
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA205347207ND0101X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110005896AMedicaid
MA110005896AMedicaid
H60989Medicare UPIN
MASX2577Medicare PIN