Provider Demographics
NPI:1922082510
Name:SZCZESNIAK, CARL J (MD)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:J
Last Name:SZCZESNIAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 4270
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-4270
Mailing Address - Country:US
Mailing Address - Phone:910-687-4188
Mailing Address - Fax:910-235-0171
Practice Address - Street 1:30 PAGE ST
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-7928
Practice Address - Country:US
Practice Address - Phone:910-687-4188
Practice Address - Fax:910-235-0171
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200300203207ZP0102X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1447293790Medicaid
SC80072235OtherSELECT HEALTH
FL7687739OtherAETNA
NC1447293790Medicaid
SC2609018OtherUNITED
SC292926Medicaid
GA625574475CMedicaid
GA625574475FMedicaid
GA625574475EMedicaid
SCP01694396OtherRR MEDICARE
GA625574475GMedicaid
GA625574475DMedicaid
SC1226037OtherWELLCARE
SC30253421OtherSELECT HEALTH
GA625574475AMedicaid
SC30253421OtherSELECT HEALTH
FL7687739OtherAETNA