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General NPI Number Information
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NPI Number | 1194954420
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Entity Type | Individual
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Provider Name | PAUL WILLIAM HALCZENKO MD
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Gender | Male
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Dates
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Enumeration Date | 07/08/2009
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Last Update Date | 08/01/2025
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Provider Practice Location Address
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Address Line | 295 MIDLAND PKWY
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City | SUMMERVILLE
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State | SC
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Zip | 29485-8104
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Country | US
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Telephone | 843-970-5255
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Fax |
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Provider Business Mailing Address
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Address Line | 1201 RAVEN RD
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City | HANAHAN
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State | SC
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Zip | 29410-8509
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Country | US
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Telephone | 321-246-2705
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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 | 2080P0203X
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Taxonomy Name | Pediatric Critical Care Medicine Physician
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License Number | ME158326
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2080P0203X
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Taxonomy Name | Pediatric Critical Care Medicine Physician
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License Number | 90515
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License Number State | SC
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Taxonomy #3
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Taxonomy Code | 2080P0203X
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Taxonomy Name | Pediatric Critical Care Medicine Physician
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License Number | 426479
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License Number State | PA
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Taxonomy #4
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Taxonomy Code | 2080P0203X
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Taxonomy Name | Pediatric Critical Care Medicine Physician
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License Number | 01071583A
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License Number State | IN
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