Provider Demographics
NPI:1841291978
Name:DZIUBA, SYLWESTER J (MD)
Entity type:Individual
Prefix:DR
First Name:SYLWESTER
Middle Name:J
Last Name:DZIUBA
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 64984
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4984
Mailing Address - Country:US
Mailing Address - Phone:410-592-9080
Mailing Address - Fax:410-592-9080
Practice Address - Street 1:900 CATON AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229-5201
Practice Address - Country:US
Practice Address - Phone:410-368-2965
Practice Address - Fax:410-951-4002
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00588542085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDR985OtherFEDERAL BS
MDS325OtherMARYLAND BLUE SHIELD
MDS325D551Medicare PIN
MDS325OtherMARYLAND BLUE SHIELD