Provider Demographics
NPI:1710952270
Name:CZERWINSKI, WITOLD PAWEL (MD)
Entity Type:Individual
Prefix:
First Name:WITOLD
Middle Name:PAWEL
Last Name:CZERWINSKI
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:PO BOX 3951
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72503-3951
Mailing Address - Country:US
Mailing Address - Phone:870-793-2800
Mailing Address - Fax:870-793-2862
Practice Address - Street 1:1368 NEELEY ST
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-5815
Practice Address - Country:US
Practice Address - Phone:870-793-2800
Practice Address - Fax:870-793-2862
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-20
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE26232084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR141671001Medicaid
AR5L677Medicare ID - Type Unspecified