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General NPI Number Information
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NPI Number | 1124249735
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Entity Type | Individual
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Provider Name | MICHAEL BLAZEJ PRZYDZIELSKI MD
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Gender | Male
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Dates
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Enumeration Date | 05/01/2007
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Last Update Date | 05/20/2024
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Provider Practice Location Address
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Address Line | 36 CLINTON ST
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City | CONCORD
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State | NH
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Zip | 03301-2359
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Country | US
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Telephone | 603-271-5300
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Fax |
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Provider Business Mailing Address
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Address Line | 12 RAYTON RD
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City | HANOVER
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State | NH
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Zip | 03755-2214
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Country | US
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Telephone | 603-727-6292
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 15847
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License Number State | NH
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 0420012022
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License Number State | VT
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 15847
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License Number State | NH
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Taxonomy #4
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 0420012022
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License Number State | VT
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