1417167545 NPI number — MS. CYNTHIA PLADZIEWICZ PHD

Table of content: MS. CYNTHIA PLADZIEWICZ PHD (NPI 1417167545)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417167545 NPI number — MS. CYNTHIA PLADZIEWICZ PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PLADZIEWICZ
Provider First Name:
CYNTHIA
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PHD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417167545
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3600 GASTON AVE STE 1155
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75246-1911
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-824-2273
Provider Business Mailing Address Fax Number:
214-826-9340

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3600 GASTON AVE STE 1155
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75246-1911
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-824-2273
Provider Business Practice Location Address Fax Number:
214-826-9340
Provider Enumeration Date:
05/24/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 031270401 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".