Provider Demographics
NPI:1982035424
Name:PRUSZCZYNSKI, BLAZEJ (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:BLAZEJ
Middle Name:
Last Name:PRUSZCZYNSKI
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2503 GRENDON DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-4002
Mailing Address - Country:US
Mailing Address - Phone:302-468-7073
Mailing Address - Fax:
Practice Address - Street 1:2503 GRENDON DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-4002
Practice Address - Country:US
Practice Address - Phone:302-468-7073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-10
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ23244111744R1102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744R1102XOther Service ProvidersSpecialistResearch Study