Provider Demographics
NPI:1902009376
Name:MAJCZAK, MARTA B (MD)
Entity Type:Individual
Prefix:
First Name:MARTA
Middle Name:B
Last Name:MAJCZAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1011 VETERANS MEMORIAL PKWY
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:RI
Mailing Address - Zip Code:02915-5061
Mailing Address - Country:US
Mailing Address - Phone:401-432-1496
Mailing Address - Fax:401-432-1524
Practice Address - Street 1:154 WATERMAN ST
Practice Address - Street 2:SUITE 8
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-3116
Practice Address - Country:US
Practice Address - Phone:860-690-9006
Practice Address - Fax:401-272-0286
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2015-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD139342084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIMD13934OtherMEDICAL LICENSE