Provider Demographics
NPI:1740696293
Name:KAZMIERCZAK, MAGDALENA (MD)
Entity type:Individual
Prefix:
First Name:MAGDALENA
Middle Name:
Last Name:KAZMIERCZAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MAGDALENA
Other - Middle Name:
Other - Last Name:KAZMIERCZAK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:56 FRANKLIN ST STE 1
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06706-1281
Mailing Address - Country:US
Mailing Address - Phone:203-709-3534
Mailing Address - Fax:
Practice Address - Street 1:56 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06706-1253
Practice Address - Country:US
Practice Address - Phone:203-709-3534
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-05
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT207504390200000X
CT642622080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program