Provider Demographics
NPI:1790798882
Name:STEPCZAK, WAWRZYNIEC LAWRENCE (MD)
Entity Type:Individual
Prefix:
First Name:WAWRZYNIEC
Middle Name:LAWRENCE
Last Name:STEPCZAK
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 1:601 PARK ST
Mailing Address - Street 2:
Mailing Address - City:HONESDALE
Mailing Address - State:PA
Mailing Address - Zip Code:18431-1445
Mailing Address - Country:US
Mailing Address - Phone:570-251-6542
Mailing Address - Fax:
Practice Address - Street 1:29 WOODLANDS DRIVE
Practice Address - Street 2:
Practice Address - City:WAYMART
Practice Address - State:PA
Practice Address - Zip Code:18472
Practice Address - Country:US
Practice Address - Phone:570-488-9770
Practice Address - Fax:570-488-9782
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD058917L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001864599Medicaid
G30901Medicare UPIN
883773FEMMedicare ID - Type Unspecified