Provider Demographics
NPI:1902858749
Name:MICHALCZYK, JOHN J (MA)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:J
Last Name:MICHALCZYK
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5407 N CHARLES STREET
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21210-2024
Mailing Address - Country:US
Mailing Address - Phone:410-433-8861
Mailing Address - Fax:410-433-1249
Practice Address - Street 1:5407 N CHARLES STREET
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21210-2024
Practice Address - Country:US
Practice Address - Phone:410-433-8861
Practice Address - Fax:410-433-1249
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC1007101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
122244OtherJOHNS HOPKINS HEALTH CARE
481450000OtherMAGELLAN
288928OtherMANAGED HEALTH NETWORK/TR
264806000OtherMAGELLAN
MD405393100Medicaid
0012OtherFED BC
226149OtherKAISER
MD61030501OtherBCBS