Provider Demographics
NPI:1194780114
Name:MACIEJEWSKI, ANDRZEJ R (MD)
Entity type:Individual
Prefix:DR
First Name:ANDRZEJ
Middle Name:R
Last Name:MACIEJEWSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3260 PROVIDENCE DR
Mailing Address - Street 2:#523
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4608
Mailing Address - Country:US
Mailing Address - Phone:907-569-1049
Mailing Address - Fax:907-563-4564
Practice Address - Street 1:3260 PROVIDENCE DR
Practice Address - Street 2:#523
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4608
Practice Address - Country:US
Practice Address - Phone:907-569-1049
Practice Address - Fax:907-563-4564
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-20
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1004693207N00000X
AK4655207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD2805Medicaid
P00117806OtherRAILROAD MEDICARE
P00117806OtherRAILROAD MEDICARE
AKK151796Medicare PIN