Provider Demographics
NPI:1528092533
Name:CHODYNICKI, MACIEJ P (MD)
Entity type:Individual
Prefix:
First Name:MACIEJ
Middle Name:P
Last Name:CHODYNICKI
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 1:1122 KENILWORTH DR
Mailing Address - Street 2:SUITE 403
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-2139
Mailing Address - Country:US
Mailing Address - Phone:410-339-5313
Mailing Address - Fax:410-339-5313
Practice Address - Street 1:1122 KENILWORTH DR
Practice Address - Street 2:SUITE 403
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-2139
Practice Address - Country:US
Practice Address - Phone:410-339-5313
Practice Address - Fax:410-339-5313
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2014-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00360802084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDKN76S11Medicare UPIN
M310Medicare ID - Type Unspecified