Provider Demographics
NPI:1154427441
Name:RADZIEWICZ, HENRY THOMAS (MD)
Entity type:Individual
Prefix:
First Name:HENRY
Middle Name:THOMAS
Last Name:RADZIEWICZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2322 SILENT STREAM CT
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-6039
Mailing Address - Country:US
Mailing Address - Phone:919-270-4288
Mailing Address - Fax:
Practice Address - Street 1:2322 SILENT STREAM CT
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-6039
Practice Address - Country:US
Practice Address - Phone:919-270-4288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA50731207RI0200X
NC9800123207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5916006Medicaid