Provider Demographics
NPI:1124314695
Name:KRECZKO, ALICJA (MD)
Entity type:Individual
Prefix:
First Name:ALICJA
Middle Name:
Last Name:KRECZKO
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 1:297 PROMENADE ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02908-5720
Mailing Address - Country:US
Mailing Address - Phone:401-490-6464
Mailing Address - Fax:401-490-6470
Practice Address - Street 1:297 PROMENADE ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02908-5720
Practice Address - Country:US
Practice Address - Phone:401-490-6464
Practice Address - Fax:401-490-6470
Is Sole Proprietor?:No
Enumeration Date:2011-06-23
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD15151207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology