Provider Demographics
NPI:1851627806
Name:KUCZEWSKI, MARC W (LICENSED HEARING INS)
Entity Type:Individual
Prefix:MR
First Name:MARC
Middle Name:W
Last Name:KUCZEWSKI
Suffix:
Gender:M
Credentials:LICENSED HEARING INS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 MAIN ST
Mailing Address - Street 2:SUITE 8
Mailing Address - City:WESTBROOK
Mailing Address - State:ME
Mailing Address - Zip Code:04092-4786
Mailing Address - Country:US
Mailing Address - Phone:207-591-4136
Mailing Address - Fax:207-591-4138
Practice Address - Street 1:11 MAIN ST
Practice Address - Street 2:SUITE 8
Practice Address - City:WESTBROOK
Practice Address - State:ME
Practice Address - Zip Code:04092-4786
Practice Address - Country:US
Practice Address - Phone:207-591-4136
Practice Address - Fax:207-591-4138
Is Sole Proprietor?:No
Enumeration Date:2009-10-27
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDL374237700000X
NHH564237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME26-2550721OtherEMPLOYER IDENTIFICATION NUMBER