Healthcare Provider Details

I. General information

NPI: 1710950449
Provider Name (Legal Business Name): DAVID S. PLADZIEWICZ MD MBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 11/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 GOVERNORS AVE
MEDFORD MA
02155-1643
US

IV. Provider business mailing address

137 MAIN STREET
MEDFORD MA
02155
US

V. Phone/Fax

Practice location:
  • Phone: 781-395-4909
  • Fax: 781-395-5081
Mailing address:
  • Phone: 781-395-4909
  • Fax: 781-395-5081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number70600
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: