Provider Demographics
NPI:1598879801
Name:JANDZINSKI, DANA I (MD)
Entity type:Individual
Prefix:DR
First Name:DANA
Middle Name:I
Last Name:JANDZINSKI
Suffix:
Gender:
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:PO BOX 221249
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28222-1249
Mailing Address - Country:US
Mailing Address - Phone:704-332-1291
Mailing Address - Fax:704-926-1832
Practice Address - Street 1:3623 LATROBE DR STE 216
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-2117
Practice Address - Country:US
Practice Address - Phone:704-332-1291
Practice Address - Fax:704-332-5206
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC815412085R0202X
NY2369882085R0202X
NC2024-036482085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY061024000039OtherFIDELIS CARE OF NY
NY000930199002OtherBCBS
NY02775253Medicaid
NY187540FFOtherPREFERRED CARE
NYP00658341OtherRR MEDICARE
NY00027790001OtherUNIVERA HEALTHCARE
NY1609206OtherINDEPENDENT HEALTH
NYRB2423Medicare PIN
NY02775253Medicaid