Provider Demographics
NPI:1295977858
Name:WALCZYSZYN, MACIEJ PIOTR (MD)
Entity type:Individual
Prefix:DR
First Name:MACIEJ
Middle Name:PIOTR
Last Name:WALCZYSZYN
Suffix:
Gender:M
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:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-384-9200
Mailing Address - Fax:704-384-6588
Practice Address - Street 1:1450 MATTHEWS TOWNSHIP PKWY STE 380
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-2389
Practice Address - Country:US
Practice Address - Phone:704-384-9200
Practice Address - Fax:704-384-6588
Is Sole Proprietor?:No
Enumeration Date:2009-03-29
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2021-01907207RP1001X, 207RC0200X, 207R00000X
NY271108174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No174400000XOther Service ProvidersSpecialist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine