Healthcare Provider Details

I. General information

NPI: 1992809065
Provider Name (Legal Business Name): THOMAS ARTHUR CISZEK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1638 OWEN DR
FAYETTEVILLE NC
28302
US

IV. Provider business mailing address

1638 OWEN DR
FAYETTEVILLE NC
28302
US

V. Phone/Fax

Practice location:
  • Phone: 910-223-1339
  • Fax: 910-486-6502
Mailing address:
  • Phone: 910-223-1339
  • Fax: 910-486-6502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number29541
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: