Provider Demographics
NPI:1881708782
Name:PISZCZEK, EWA D (MD)
Entity type:Individual
Prefix:
First Name:EWA
Middle Name:D
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 1:3901 COCONUT PALM DR STE 120
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33619-8362
Mailing Address - Country:US
Mailing Address - Phone:813-289-6597
Mailing Address - Fax:865-769-3454
Practice Address - Street 1:3901 COCONUT PALM DR STE 120
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33619-8362
Practice Address - Country:US
Practice Address - Phone:813-289-6597
Practice Address - Fax:865-769-3454
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD12187207R00000X
FLME107864207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9024203Medicaid
FL002756400Medicaid
RI9024203Medicaid
RI007058730Medicare PIN