Provider Demographics
NPI:1316911506
Name:CIESZKOWSKI, ROZA B (MD)
Entity type:Individual
Prefix:
First Name:ROZA
Middle Name:B
Last Name:CIESZKOWSKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ROZA
Other - Middle Name:B
Other - Last Name:ADAMOWSKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:7525 MEMORIAL PARKWAY SW SUITE B
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35802-2260
Mailing Address - Country:US
Mailing Address - Phone:256-529-9921
Mailing Address - Fax:
Practice Address - Street 1:7525 MEMORIAL PARKWAY SW SUITE B
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35802-2260
Practice Address - Country:US
Practice Address - Phone:256-529-9921
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-14
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL223352084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL069893682OtherTRICARE
AL51008409OtherBLUE CROSS BLUE SHIELD
AL069893682OtherTRICARE
ALG92037Medicare UPIN