Healthcare Provider Details

I. General information

NPI: 1841261245
Provider Name (Legal Business Name): MICHAEL JOHN MARCINCZYK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 02/22/2023
Certification Date: 02/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2235 STAPLES MILL RD STE 104
RICHMOND VA
23230-2942
US

IV. Provider business mailing address

PO BOX 277771
ATLANTA GA
30384-7771
US

V. Phone/Fax

Practice location:
  • Phone: 804-355-9729
  • Fax:
Mailing address:
  • Phone: 610-644-8900
  • Fax: 484-924-0053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number0101230296
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: