Healthcare Provider Details

I. General information

NPI: 1477637189
Provider Name (Legal Business Name): MARZENA E KRAWIEC MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 07/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2131 S 17TH ST COASTAL CHILDRENS SERVICES, PLLC
WILMINGTON NC
28401-7407
US

IV. Provider business mailing address

2131 S 17TH ST COASTAL CHILDRENS SERVICES, PLLC
WILMINGTON NC
28401-7407
US

V. Phone/Fax

Practice location:
  • Phone: 910-667-9402
  • Fax: 877-665-4450
Mailing address:
  • Phone: 910-667-9402
  • Fax: 877-665-4450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number34696
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number2012-01877
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: