Provider Demographics
NPI:1992809065
Name:CISZEK, THOMAS ARTHUR (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:ARTHUR
Last Name:CISZEK
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 1:1638 OWEN DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28302
Mailing Address - Country:US
Mailing Address - Phone:910-223-1339
Mailing Address - Fax:910-486-6502
Practice Address - Street 1:1638 OWEN DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28302
Practice Address - Country:US
Practice Address - Phone:910-223-1339
Practice Address - Fax:910-486-6502
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC295412080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0102COtherBCBS
NC8922498Medicaid
0102COtherBCBS