Provider Demographics
NPI:1023161262
Name:PISZCZEK, CAROLYN COGHILL (MD)
Entity type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:COGHILL
Last Name:PISZCZEK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 NW 22ND AVE
Mailing Address - Street 2:NORTHUP BLDG, SUITE 23
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210
Mailing Address - Country:US
Mailing Address - Phone:503-413-7529
Mailing Address - Fax:
Practice Address - Street 1:1050 NW 22ND AVENUE, NORTHUP BLDG.,
Practice Address - Street 2:SUITE 23
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210
Practice Address - Country:US
Practice Address - Phone:503-413-7529
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171000000X
NE24857207V00000X
CA133637207V00000X
ORMD171024207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No171000000XOther Service ProvidersMilitary Health Care Provider