Provider Demographics
NPI:1770651259
Name:OSIPOWICZ, TADEK
Entity Type:Individual
Prefix:
First Name:TADEK
Middle Name:
Last Name:OSIPOWICZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7718 BRADLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-1443
Mailing Address - Country:US
Mailing Address - Phone:301-365-2300
Mailing Address - Fax:301-365-4203
Practice Address - Street 1:7718 BRADLEY BLVD
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-1443
Practice Address - Country:US
Practice Address - Phone:301-365-2300
Practice Address - Fax:301-365-4203
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15696225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD231188700Medicaid
MD1046950001Medicare NSC
MD521123Medicare ID - Type Unspecified