Provider Demographics
NPI:1689647463
Name:PUCILOWSKI, OLGIERD (MD, PHD)
Entity Type:Individual
Prefix:
First Name:OLGIERD
Middle Name:
Last Name:PUCILOWSKI
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1203 WILLOW DR
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27517-3029
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:PSYCHIATRIC AND ADDICTIN THERAPEUTIC HEALING SERVICES
Practice Address - Street 2:800 N JUSTICE STREET
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28791-3410
Practice Address - Country:US
Practice Address - Phone:828-696-4250
Practice Address - Fax:828-696-4256
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2000001162084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2281241BOtherMEDICARE PTAN
NCP01174529OtherRR MEDICARE