MEDICARE: ANDREW J PELCZAR MD

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	208600000X	Surgery Physician	0101234384	VA

General Provider Information

NPI Number	:	1578645099
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW J PELCZAR MD

Provider Business Mailing Address
First Line	:	PO BOX 1668
Second Line	:
City	:	SHELTON
State	:	WA
Zip	:	98584-5001
Country	:	US
Telephone Number	:	360-427-9549
Fax Number	:	360-475-5560

Provider Business Practice Location Address
First Line	:	1701 N 13TH ST
Second Line	:
City	:	SHELTON
State	:	WA
Zip	:	98584-2077
Country	:	US
Telephone Number	:	360-426-2653
Fax Number	:	360-475-5560

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

Provider Enumeration Date	:	10/20/2006
Last Update Date	:	11/17/2020

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