Provider Demographics
NPI:1710972153
Name:RYSKIEWICH, PAUL D (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:D
Last Name:RYSKIEWICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:200 PROVIDENCE RD
Mailing Address - Street 2:SUITE101
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28207-1437
Mailing Address - Country:US
Mailing Address - Phone:704-749-5800
Mailing Address - Fax:704-749-5819
Practice Address - Street 1:200 PROVIDENCE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-1437
Practice Address - Country:US
Practice Address - Phone:704-749-5800
Practice Address - Fax:704-749-5819
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2012-02-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC27301207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8974108Medicaid
NC210105AMedicare PIN
NC8974108Medicaid