Healthcare Provider Details

I. General information

NPI: 1427032200
Provider Name (Legal Business Name): TIMOTHY M BARCZAK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2005
Last Update Date: 03/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 MONTAUK AVE
NEW LONDON CT
06320-4738
US

IV. Provider business mailing address

345 MONTAUK AVE
NEW LONDON CT
06320-4738
US

V. Phone/Fax

Practice location:
  • Phone: 860-444-6711
  • Fax: 860-437-0650
Mailing address:
  • Phone: 860-444-6711
  • Fax: 860-437-0650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number024666
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: