Provider Demographics
NPI:1356374433
Name:MUZYCHKA, DARIA L (MD)
Entity type:Individual
Prefix:DR
First Name:DARIA
Middle Name:L
Last Name:MUZYCHKA
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 1:18323 WILDLIFE WAY DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70817-3994
Mailing Address - Country:US
Mailing Address - Phone:225-752-1302
Mailing Address - Fax:
Practice Address - Street 1:17000 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-3246
Practice Address - Country:US
Practice Address - Phone:225-379-8109
Practice Address - Fax:225-236-5486
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10123R207R00000X
ND15330208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1977136Medicaid
E58463Medicare UPIN
5U017Medicare ID - Type Unspecified