Provider Demographics
NPI:1548202492
Name:MARCINIAK, RICHARD DWIGHT (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:DWIGHT
Last Name:MARCINIAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2860 S CIRCLE DR
Mailing Address - Street 2:SUITE 160
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-4113
Mailing Address - Country:US
Mailing Address - Phone:719-473-2346
Mailing Address - Fax:719-577-9627
Practice Address - Street 1:2860 S CIRCLE DR
Practice Address - Street 2:SUITE 160
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-4113
Practice Address - Country:US
Practice Address - Phone:719-473-2346
Practice Address - Fax:719-577-9627
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO278892084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
COUM01278894Medicaid
CO260049678OtherRAILROAD MEDICARE
COUM01278894Medicaid
COC334448Medicare PIN