Provider Demographics
NPI:1285611921
Name:LYSZCZARZ, JOHN L III (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:L
Last Name:LYSZCZARZ
Suffix:III
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:PSC 819 BOX 1829
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AE
Mailing Address - Zip Code:09645-1801
Mailing Address - Country:US
Mailing Address - Phone:0113495-682-3408
Mailing Address - Fax:
Practice Address - Street 1:PSC 819 BOX 1829
Practice Address - Street 2:
Practice Address - City:FPO
Practice Address - State:AE
Practice Address - Zip Code:09645-1801
Practice Address - Country:US
Practice Address - Phone:0113495-682-3408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012233372084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry