Provider Demographics
NPI:1699043133
Name:MACIEJ CHODYNICKI MD LLC
Entity Type:Organization
Organization Name:MACIEJ CHODYNICKI MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MACIEJ
Authorized Official - Middle Name:
Authorized Official - Last Name:CHODYNICKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:443-762-1683
Mailing Address - Street 1:1122 KENILWORTH DR STE 403
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-2147
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1122 KENILWORTH DR STE 403
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-2147
Practice Address - Country:US
Practice Address - Phone:443-762-1683
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-13
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00630802084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction PsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD408237100Medicaid
MD408237100Medicaid