MEDICARE: DR. EDWARD MICHAEL GALICZYNSKI JR. DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	2024-00253	NC

General Provider Information

NPI Number	:	1255517041
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWARD MICHAEL GALICZYNSKI JR. DO

Provider Business Mailing Address
First Line	:	2224 W NORTHERN AVE STE D300
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85021-5099
Country	:	US
Telephone Number	:	602-277-1449
Fax Number	:	602-277-9984

Provider Business Practice Location Address
First Line	:	11640 NORTHPARK DR STE 200
Second Line	:
City	:	WAKE FOREST
State	:	NC
Zip	:	27587-5741
Country	:	US
Telephone Number	:	919-436-4124
Fax Number	:	919-439-9645

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/11/2008
Last Update Date	:	05/06/2024

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