Provider Demographics
NPI:1851396832
Name:OLEARCZYK, MATTHEW A (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:A
Last Name:OLEARCZYK
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 1:3890 JOHNS CREEK PKWY
Mailing Address - Street 2:STE 320
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-1284
Mailing Address - Country:US
Mailing Address - Phone:770-232-5253
Mailing Address - Fax:770-232-5202
Practice Address - Street 1:3890 JOHNS CREEK PKWY
Practice Address - Street 2:STE 320
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-1284
Practice Address - Country:US
Practice Address - Phone:770-232-5253
Practice Address - Fax:770-232-5202
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA053010207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA04BDCMBMedicare UPIN
GAH84790Medicare UPIN