Provider Demographics
NPI:1912236696
Name:PIETRZAK, THOMAS ANDREW
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:ANDREW
Last Name:PIETRZAK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 CLARENDON ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-3722
Mailing Address - Country:US
Mailing Address - Phone:617-536-0944
Mailing Address - Fax:617-536-8916
Practice Address - Street 1:206 CLARENDON ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-3722
Practice Address - Country:US
Practice Address - Phone:617-536-0944
Practice Address - Fax:617-536-8916
Is Sole Proprietor?:No
Enumeration Date:2009-12-09
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program