Provider Demographics
NPI:1104900125
Name:CZARNECKI, DOROTHY (MD)
Entity type:Individual
Prefix:
First Name:DOROTHY
Middle Name:
Last Name:CZARNECKI
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 1:9412 ACADEMY RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19114
Mailing Address - Country:US
Mailing Address - Phone:215-676-2242
Mailing Address - Fax:215-676-4938
Practice Address - Street 1:9412 ACADEMY ROAD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114
Practice Address - Country:US
Practice Address - Phone:215-676-2242
Practice Address - Fax:215-676-4938
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD006592E207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01398061Medicaid
PA01398061Medicaid
B32852Medicare UPIN