MEDICARE: DR. DARIUSZ HORDEJUK M.D.

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	207R00000X	Internal Medicine Physician	224132	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	J28863	OTHER	MA	BCBSMA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902884331
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DARIUSZ HORDEJUK M.D.

Provider Business Mailing Address
First Line	:	275 SANDWICH ST
Second Line	:	C/O CATHY GREY
City	:	PLYMOUTH
State	:	MA
Zip	:	02360-2183
Country	:	US
Telephone Number	:	508-746-2000
Fax Number	:	508-830-2502

Provider Business Practice Location Address
First Line	:	275 SANDWICH ST
Second Line	:	C/O CATHY GREY
City	:	PLYMOUTH
State	:	MA
Zip	:	02360-2183
Country	:	US
Telephone Number	:	508-746-2000
Fax Number	:	508-830-2502

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

Provider Enumeration Date	:	01/05/2006
Last Update Date	:	11/28/2007

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