Provider Demographics
NPI:1225396930
Name:GICEWICZ, ADAM (MD)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:GICEWICZ
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 1:758 EAST ST
Mailing Address - Street 2:BERKSHIRE HEALTH PEDIATRICS
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201
Mailing Address - Country:US
Mailing Address - Phone:134-448-8212
Mailing Address - Fax:413-443-5296
Practice Address - Street 1:758 EAST ST
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-5326
Practice Address - Country:US
Practice Address - Phone:134-448-8212
Practice Address - Fax:413-443-5296
Is Sole Proprietor?:No
Enumeration Date:2012-05-01
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA1017844208000000X
NY280183208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics