Provider Demographics
NPI:1992385710
Name:PACZYNSKI, MADELINE MARIE (PA)
Entity type:Individual
Prefix:MS
First Name:MADELINE
Middle Name:MARIE
Last Name:PACZYNSKI
Suffix:
Gender:
Credentials:PA
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Mailing Address - Street 1:PO BOX 7412011
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-2011
Mailing Address - Country:US
Mailing Address - Phone:314-286-1967
Mailing Address - Fax:314-286-1985
Practice Address - Street 1:4488 FOREST PARK AVE
Practice Address - Street 2:DIV NEUROLOGY AGING AND DEMENTIA, STE 160
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-2283
Practice Address - Country:US
Practice Address - Phone:314-286-1967
Practice Address - Fax:314-286-1985
Is Sole Proprietor?:No
Enumeration Date:2021-04-14
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2022004607363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO220106937Medicaid